Evaluation of performance in preanalytical phase EQA: can laboratories mitigate common pitfalls?

Preanalytical phase is an elemental part of laboratory diagnostics, but is prone to humane errors. The aim of this study was to evaluate performance in preanalytical phase external quality assessment (EQA) cases. We also suggest preventive actions for risk mitigation.

We included 12 EQA rounds (Labquality Ltd.) with three patient cases (36 cases, 54-111 participants, 7-15 countries) published in 2018-2023. We graded performance according to percentage of correct responses in each case as ≥900 % excellent, 70-89 % good, 50-69 % satisfactory, 30-49 % fair and <30 % poor. Performance was simultaneously failed with ≥10 % of responses leading to harmful events.

Overall performance was excellent in 7, good in 12, satisfactory in 10, fair in 4 and poor in 3 cases. Additionally, 7 cases showed failed performance. Routine requests with incorrect sample tubes or incorrect sample handling were detected with good performance. Lower performance was seen with sudden abnormal results, with rare requests, with false patient identification (never-events) and with incorrect test requests. Information technology (IT) solutions (preanalytical checklists, autoverification rules and patient specific notifications) could have prevented 33 of 36 preanalytical errors.

While most common errors were detected with good performance, samples with rare requests or those requiring individualised consideration are vulnerable to human misinterpretation. In many instances, samples with preanalytical errors should have been identified and rejected before reaching the laboratory or being directed to analysis. Optimising IT solutions to effectively detect these preanalytical errors allows for focus on infrequent events demanding accessible professional consultation. EQA preanalytical cases may help in education of correct actions in these occasions.