Exploring the iceberg of errors in laboratory medicine

Area of Science:

• Clinical Laboratory Science
• Healthcare Quality Improvement
• Diagnostic Medicine

Background:

• Analytical errors in clinical laboratories have significantly decreased over recent decades.
• Pre- and post-analytical phases of the total testing process (TTP) are more prone to errors than the analytical phase.
• Many errors occur outside the laboratory's direct control, in pre-pre-analytic and post-post analytic steps.

Purpose of the Study:

• To investigate defects in the total testing process (TTP) that negatively impact patient care.
• To consider all consequences of laboratory testing errors, regardless of the phase or responsible party.
• To highlight the need for evidence-based quality indicators for laboratory medicine.

Main Methods:

• Review of existing evidence on analytical errors in clinical laboratories.
• Analysis of diagnostic errors in primary care and emergency departments.
• Identification of common and specific faults affecting diagnostic errors.

Main Results:

• Inappropriate test requesting and incorrect interpretation are major contributors to diagnostic errors across disciplines.
• Patient misidentification and result communication issues are key areas for quality improvement.
• Errors in laboratory medicine require specific preventive and corrective actions.

Conclusions:

• A patient-centered approach necessitates examining the entire total testing process (TTP) for potential defects.
• Developing, implementing, and monitoring evidence-based quality indicators is essential for laboratory error reduction.
• Practices must proactively identify weaknesses in their TTP and implement appropriate remedies.