Strategies for effective occurrence Management in Resource-Limited Clinical Laboratories: Challenges and practical...

Clinical laboratory results guide the vast majority of medical management pathways and Occurrence Management ensures diagnostic safety across the total testing process (TTP). However, execution in resource-limited settings (RLS) is severely hindered by infrastructural constraints like grid instability, workforce shortages, unreliable paper-based data systems, and punitive institutional cultures that suppress incident reporting and error capture.

This review evaluates unique system-level and organizational barriers to error management in low-resource laboratories and synthesizes a scalable, phased operational framework to optimize continuous quality improvement and patient safety.

A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and AJOL for publications from January 2010 to April 2026. Guided by the TTP framework integrated with the Plan-Do-Check-Act (PDCA) cycle, a PRISMA-informed screening isolated 67 eligible records for thematic synthesis and framework development.

Laboratory errors are highly asymmetric, with up to 68.2% concentrated in the pre-analytical phase. Primary failure points stem from human-system interface lapses, manual transcription workflows, and cold-chain failures during power outages. To bridge the gap with international quality standards (ISO 15189:2022), this paper establishes a phased, six-stage occurrence management roadmap scaled for varying tiers of healthcare delivery. Practical, low-cost interventions include implementing non-punitive "just culture" reporting policies, using cost-effective in-house pooled patient sera for quality control, deploying offline-capable open-source laboratory information systems, and forming interdisciplinary clinical-laboratory committees. To facilitate bench deployment, the framework is supported by open-access templates designed to guide standardized reporting, structured root cause analysis (Five Whys/Ishikawa checklists), corrective actions, ledger tracking, and automated Process Sigma performance indicator dashboard monitoring.

Strengthening error tracking in RLS is fully viable through targeted operational changes without extensive capital investment. Shifting from an individual blame orientation to system-centric learning, paired with stepwise accreditation mentorship models (SLMTA/SLIPTA), significantly reduces diagnostic defects and ensures health system sustainability.