Reducing sample rejection in Durban, South Africa

Area of Science:

• Clinical Chemistry
• Laboratory Medicine
• Quality Improvement

Background:

• Specimen rejections in clinical chemistry cause result delays, potentially impacting patient care.
• Identifying rejection rates and reasons is crucial for optimizing laboratory workflows.

Purpose of the Study:

• To measure clinical chemistry specimen rejection rates and their causes.
• To evaluate the effectiveness of an intervention campaign aimed at reducing rejections.
• To identify clinical units with the highest rates of insufficient specimens.

Main Methods:

• Comparative analysis of specimen rejection data from two distinct periods (2016 and 2018-2019).
• Implementation of a 7-intervention campaign to mitigate specimen rejections.
• Assessment of rejection rates, target adherence, and reasons for rejection pre- and post-intervention.
• Traceability of insufficient specimens to originating clinical units.

Main Results:

• Overall specimen rejection rate decreased from 1.4% to 1.2% post-intervention.
• The number of months meeting the target rejection rate (<1.2%) significantly increased from 2 to 6.
• Rejections due to insufficient, hemolyzed, or 'too-old' specimens significantly decreased, though insufficient specimens remained the primary reason.
• Neonatal and pediatric units contributed disproportionately to insufficient specimen rejections.

Conclusions:

• The intervention campaign effectively reduced overall and monthly specimen rejection rates.
• While specific rejection reasons decreased, insufficient specimens persist as the most frequent issue.
• Neonatal and pediatric units are key areas for targeted interventions to further reduce specimen rejections.