Laboratory-associated and diagnostic errors: a neglected link

Clinical laboratories play a vital role in patient care, but many diagnostic errors are associated with laboratory testing. The past decades have seen sustained improvements in analytical performances but the error rates, particularly in pre- and post-analytical phases is still high. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, the awareness about the importance of extra-analytical aspects in laboratory quality is a recent achievement. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates and thereby improve patient safety. In the interests of patients, any direct or indirect negative consequence related to a laboratory test must be considered, irrespective of which step is involved and whether the error depends on a laboratory professional (e.g., calibration or testing error) or a non-laboratory operator (e.g., inappropriate test request, error in patient identification and/or blood collection). Data collected in various clinical settings demonstrate that many diagnostic errors are associated with laboratory testing. In particular, errors are due to inappropriate test request and/or result interpretation and utilization. Collaborations between laboratory professionals and other care providers, namely clinicians and nurses, are needed to achieve the goal of improved patient safety.