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Enhancing accuracy in clinical laboratories: a study on error identification via delta check in high-volume settings
Muhammad Shariq Shaikh1, Syed Bilal Hashmi1, Sibtain Ahmed1
1Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
International Journal of Health Care Quality Assurance
|December 1, 2025
Summary
Delta check alerts effectively identify pre-analytical errors like mislabeling and sample dilution in laboratory testing. Optimizing these alerts enhances laboratory quality assurance and patient safety by reducing diagnostic errors.
Area of Science:
- Clinical laboratory science
- Hematology
- Quality assurance in healthcare
Background:
- Medical laboratories are crucial for diagnosis, with ~70% of clinical decisions relying on their results.
- Robust quality assurance, including delta check alerts, is essential for ensuring laboratory result accuracy.
- Delta check alerts flag significant changes in consecutive patient test results.
Purpose of the Study:
- To evaluate the effectiveness of delta check alerts in detecting mean corpuscular volume (MCV) errors.
- To assess the impact of these alerts on patient safety and diagnostic precision in a high-volume laboratory.
Main Methods:
- A cross-sectional study analyzed inpatient complete blood count (CBC) samples from January to March 2024.
- Delta check events were defined as MCV changes >5 fL within 24 hours.
- Valid errors were categorized as pre-analytical or analytical; invalid errors were clinically explained.
Main Results:
- 1,779 (1.19%) MCV delta check alerts were generated from 149,286 CBC samples.
- Most alerts (95.2%) were invalid, primarily due to blood transfusions.
- Valid errors (4.8%) included mislabeling (75.2%) and sample dilution (22.3%).
Conclusions:
- Delta check alerts are valuable for identifying critical pre-analytical errors, particularly mislabeling and dilution.
- Optimizing alert thresholds and automating processes can improve efficiency and reduce false positives.
- Implementing delta checks enhances laboratory quality assurance, patient safety, and diagnostic accuracy.
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