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Published on: August 3, 2018
Ruhan Wei1, William Légaré1, Adam J McShane1
1Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA.
This article examines how automated software rules in clinical laboratories can identify common preanalytical errors, specifically focusing on sample turbidity and delayed processing, to ensure accurate patient test reporting.
Area of Science:
Background:
Clinical laboratories frequently encounter inaccuracies during the initial stages of specimen processing, yet the extent of these issues remains a significant challenge for diagnostic reliability. Prior research has shown that the majority of testing mistakes originate before analysis occurs. Automated software protocols offer a potential solution to mitigate these risks by flagging problematic samples before results reach clinicians. However, the specific efficacy of these digital safeguards in identifying distinct error types requires further investigation. This gap motivated an examination of how automated systems handle common laboratory complications. No prior work had resolved the exact frequency of specific alarm triggers in diverse clinical settings. That uncertainty drove the need for a detailed assessment of existing quality control mechanisms. The following analysis explores how these digital tools identify and manage potential reporting errors.
Purpose Of The Study:
The aim of this study is to evaluate how automated software rules can detect and mitigate preanalytical errors in clinical laboratory testing. Preanalytical mistakes represent the most common source of inaccuracies in diagnostic reports. By implementing digital quality checks, laboratories seek to prevent the release of unreliable patient data. This research investigates the effectiveness of specific autoverification protocols in identifying common sample interferences. The authors focus on two primary categories: turbidity/lipemia alerts and pseudohypoglycemia/pseudohyperkalemia warnings. Understanding these triggers is vital for improving overall laboratory performance and patient safety. The study explores the underlying causes of these alarms to provide actionable insights for clinical staff. This investigation addresses the need for robust error detection mechanisms in modern medical settings.
Main Methods:
The investigators conducted a retrospective review of laboratory alarm data to assess the performance of automated quality rules. They examined records from a clinical facility to identify the root causes of specific diagnostic flags. The review approach focused on two distinct categories: turbidity/lipemia alerts and pseudohypoglycemia/pseudohyperkalemia warnings. Researchers categorized alarm triggers by comparing automated flags against documented sample processing times and physical characteristics. They evaluated the success of centrifugation as a corrective measure for turbid specimens. The team calculated the percentage of alarms attributed to specific preanalytical factors. This systematic evaluation provided insights into the reliability of existing software-based error detection protocols. The methodology emphasizes the practical application of digital tools in routine clinical testing environments.
Main Results:
The strongest finding indicates that the vast majority of turbidity/lipemia alarms stem from sample turbidity rather than lipemia. Specifically, 96% of direct bilirubin, 95% of aspartate transaminase, and 98% of alanine transaminase alarms were linked to turbidity. Regarding delayed processing, 30% of potassium results exceeding 6.0 mmol/L were associated with delayed separation. Similarly, 50% of glucose results below 40 mg/dL were attributed to delayed separation from cellular material. These data demonstrate that automated rules successfully identify samples requiring further intervention. The results highlight a clear distinction between the causes of common laboratory interference. These findings suggest that software-based checks effectively flag samples that would otherwise produce erroneous reports. The evidence confirms the utility of these algorithms in managing preanalytical quality.
Conclusions:
The authors suggest that automated software rules effectively identify common preanalytical issues before final results are released. These systems provide a necessary layer of protection against reporting inaccurate clinical data. The findings indicate that sample turbidity is a more frequent cause of alarms than true lipemia. Laboratory staff should consider standard centrifugation as a primary intervention for clearing turbid specimens. Delayed separation of cellular material remains a significant contributor to pseudohypoglycemia and pseudohyperkalemia occurrences. Implementing these specific digital checks helps maintain high standards of diagnostic precision. Future efforts should focus on refining these algorithms to better distinguish between various causes of sample interference. This synthesis highlights the utility of automated monitoring in modern laboratory workflows.
The researchers propose that automated rules flag samples with high turbidity or delayed processing. For instance, they observed that 96% of direct bilirubin alarms were triggered by turbidity rather than lipemia, while 50% of low glucose results were linked to delayed separation.
The authors highlight two specific rules: one for turbidity or lipemia detection and another for identifying pseudohypoglycemia or pseudohyperkalemia. These tools act as digital gatekeepers to prevent the release of potentially erroneous patient data.
The authors indicate that standard centrifugation is necessary to resolve turbidity issues. If samples remain cloudy, they suggest that higher speeds and longer durations are required to effectively clear truly lipemic specimens.
The study utilizes laboratory alarm data to evaluate performance. Specifically, they analyzed 98% of alanine transaminase alarms and 30% of high potassium results to quantify the frequency of preanalytical interference.
The researchers measured the frequency of specific alarms against actual sample conditions. They found that 95% of aspartate transaminase alarms were caused by turbidity, whereas 30% of potassium results exceeding 6.0 mmol/L were associated with delayed separation.
The researchers propose that these automated systems are essential for preventing the reporting of incorrect results. They claim that such digital oversight improves overall laboratory quality by catching errors that might otherwise go unnoticed.