Preanalytical error occurrence rate in clinical chemistry laboratory of a public hospital in India

The pre and post analytical phase in a testing cycle contributes up to 93% of total laboratory errors. Hence, it is of utter importance for the laboratory to study error occurrence rates during the testing cycle and implement a quality improvement plan to release an accurate result.

The present study was conducted during the period 2008 - 2009 in the clinical biochemistry lab in Lady Hardinge Medical College and associated hospitals. During a 6 month period 32,589 samples were monitored for major preanalytical problems at the receiving counter of the laboratory.

Out of all laboratory problems, up to 61% are associated with the preanalytical phase in the lab. Out of this, 33% of the errors are associated with the test request forms, 18% errors with sample collection in glass vials, and 3% errors associated with sample processing in the laboratory. As per Quality Improvement policy of the lab, a closed blood evacuation system (vacutainers) has been implemented for sample collection. Post implementation, preanalytical error rate has been reduced to 48%, however, tube filling errors still remain the major problem noted.

Based on these observations, transcription errors related to test request forms is of great concern and needs corrective measures via proper educational programs. If this area is compromised it can lead to adverse patient outcome. However, with the use of vacutainers a better specimen quality and health care worker safety is achieved. It also decreases inconvenience to the patient.