Exploring the initial steps of the testing process: frequency and nature of pre-preanalytic errors

Area of Science:

• Clinical Laboratory Science
• Healthcare Quality Improvement
• Medical Diagnostics

Background:

• Limited data exists on errors in the pre-preanalytic phase of laboratory testing.
• This phase encompasses initial steps from physician request to lab specimen delivery.
• Understanding these errors is vital for improving overall testing accuracy.

Purpose of the Study:

• To evaluate the frequency and nature of pre-preanalytic errors.
• To observe initial laboratory testing procedures in clinical wards.
• To identify specific error types and nonconformities.

Main Methods:

• A 1-week observational phase identified procedures in 3 clinical wards.
• A 6-month study recorded nonconformities and errors.
• Data included 8547 test requests, 15917 blood tubes, and 52982 tests.

Main Results:

• High error rates observed in order transmission (29916 ppm) and hemolyzed samples (2537 ppm).
• Patient misidentification occurred at 352 ppm.
• Common nonconformities included missing patient names on requests and inadequate identity checks during blood draws.

Conclusions:

• Pre-preanalytic errors are relatively common in laboratory testing.
• There is a need for standardized operating procedures in the initial testing phases.
• Continuous monitoring of compliance with these procedures is essential.