Evaluation of biological specimen acceptability in a complex clinical laboratory before and after implementing...

Continuous monitoring of specimen acceptability, collection and transport can result in the prompt identification and correction of problems, leading to improved patient care and a reduction in unnecessary redraws and delays in reporting results. This study aims to identify unacceptable blood specimens and to calculate the specimen rejection rate (SRR) before and after the implementation of automated checks of serum indices. This study was conducted between January 2009 and December 2010. The number of rejected specimens, location and reason for rejection were recorded. The Architect c8000 analyser (Abbott, Illinois, USA) was used to assess serum indices based on characteristic spectral patterns and mathematical manipulations of absorbance values measured at several wavelengths. The SRR was calculated, and the target cut-off value for the SRR was < 0.5%, as established by the College of American Pathologists (CAP). The SRR values were 0.13% and 0.21% for the years 2009 and 2010, respectively. Haemolysis was the most significant reason for sample rejection, with cumulative rejection rates (CRR) of 49.3% and 61.4% for 2009 and 2010, respectively. Adult intensive care units (ICUs) had the most sample rejections (23.5%), followed by neonatal ICUs (13.8%), cardiac ICUs (13%), paediatric ICUs (10.8%) and long-term wards (10.5%), of which 60%, 79%, 84.9%, 36.6% and 75%, respectively, of the rejected samples were haemolysed. The increase in rejected samples may be due to an improvement in staff awareness of sample rejection, aided by automatic sample integrity grading by automated chemistry analysis systems.