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

Area of Science:

• Laboratory diagnostics
• Quality management in healthcare
• Patient safety

Background:

• The preanalytical phase is crucial for accurate laboratory diagnostics but is susceptible to human errors.
• External quality assessment (EQA) provides a framework for evaluating and improving laboratory performance.

Purpose of the Study:

• To evaluate laboratory performance in handling preanalytical phase external quality assessment (EQA) cases.
• To identify specific error types and suggest preventive actions for risk mitigation.

Main Methods:

• Analysis of 12 EQA rounds (2018-2023) involving 36 patient cases and 54-111 participants from multiple countries.
• Performance grading based on the percentage of correct responses, with specific criteria for excellent, good, satisfactory, fair, and poor performance.
• Identification of 'never-events' and assessment of potential prevention through information technology (IT) solutions.

Main Results:

• Overall performance was rated as excellent in 7 cases, good in 12, satisfactory in 10, fair in 4, and poor in 3 cases, with 7 cases showing failed performance.
• Common errors like incorrect sample tubes or handling were managed with good performance.
• Lower performance was observed for rare requests, abnormal results, false patient identification, and incorrect test requests. IT solutions could have prevented 33 of 36 errors.

Conclusions:

• While common preanalytical errors are often detected, rare requests and those needing individualized assessment remain vulnerable to misinterpretation.
• Many preanalytical errors should be identified and samples rejected before laboratory analysis.
• Optimizing IT solutions is key to detecting preanalytical errors, allowing focus on complex cases and enhancing professional consultation. EQA cases are valuable educational tools.