Evaluation of specimen rejection rates in the preanalytical phase and nurses' experiences: a mixed design study

The preanalytical phase is considered the most error-prone part of laboratory testing and significantly contributes to medical errors. Specimen rejections during this phase can delay diagnosis and treatment, compromise patient safety, and increase healthcare costs. Understanding the causes of these rejections is essential for quality improvement.

This study aimed to determine specimen rejection rates during the preanalytical phase and to explore nurses' experiences related to these rejections.

A mixed-methods design was used. In the quantitative phase, one-year retrospective data were collected from the microbiology and biochemistry laboratories of a university hospital. In the qualitative phase, individual in-depth interviews were conducted with nurses working in clinics with the highest rejection rates. Thematic analysis was used to evaluate qualitative data.

A total of 14,290 specimens were rejected in the biochemistry laboratory and 4,220 in the microbiology laboratory. The most frequent reasons for rejection were insufficient volume, hemolysis, and coagulation. Three main themes emerged from the interviews: [1] challenges in the preanalytical process [2], contributing factors to errors, and [3] emotional impact on nurses. Nurses highlighted issues such as lack of institutional support, inadequate training, patient cooperation difficulties, communication gaps, and stressful work environments. Emotional consequences included frustration, fatigue, and anxiety.

Preanalytical errors result from a combination of institutional, interpersonal, and environmental factors. These errors not only affect lab performance but also harm nurses' psychological well-being. Interventions should aim to improve workflow, enhance training, and offer emotional support to reduce rejection rates and promote patient safety.

Not applicable.