Quality improvements in the preanalytical phase: focus on urine specimen workflow

In the past, laboratories have addressed issues of preanalytical variability in an opportunistic way, addressing discrete parts of the preanalytical process, such as patient identification, specimen rejection, and blood/urine culture contamination. To obtain needed quality improvements and error reduction, it is necessary to look at the preanalytical process as a whole - from test ordering to the moment the specimen is processed by the analyzer and apply process improvement methodologies, such as LEAN and Six Sigma. To achieve this, laboratories should map the preanalytical phase in its entirety, identify steps that are potential causes of unnecessary variability that lead can to laboratory errors, and find ways either to remove them or error proof them. At the same time, by using this approach it is possible to reduce unnecessary waste and obtain needed process efficiencies.