pre analytical and post analytical errors

Specimen collections are done by nonlaboratory personnel in all the hospital departments or wards. eCollection 2017. Jones Hjelmgren H, Ygge BM, Nordlund B, Andersson N. BMC Nurs. Other common errors with post-analytical test results include: Recognition and documentation of these errors are crucial phases in enhancing the quality of laboratory medicine. Characterization and mathematical correction of hemolysis interference in selected Hitachi 717 assays, Chemistry specimen acceptability: A College of American Pathologists Q-Probes study of 453 laboratories, Identification of preanalytical mistakes in the stat section of the clinical laboratory, Complete blood count specimen acceptability: A College of American Pathologists Q-Probes study of 703 laboratories, Task analysis revisited: Refining the phlebotomy technician scope of practice and assessing longitudinal change in competencies, Causes, consequences, detection and prevention of identification errors in laboratory diagnostics, American Society of Clinical Pathologists, A novel high-resolution melting analysis strategy for detecting cystic fibrosiscausing variants, Clinical impacts of the rapid diagnostic method on positive blood cultures, Nitrate Reductase Assay for Rapid Determination of Methicillin-Resistant Staphylococcus aureus Clinical Isolates, Relationship between the systemic immune-inflammatory index and the severity of acute bronchiolitis in children, About the American Society for Clinical Pathology, Receive exclusive offers and updates from Oxford Academic, Evaluation of the Preanalytical Interference of Hemoglobin, Bilirubin, or Lipids in Therapeutic Drug Monitoring Assays on Beckman Coulter AU Analyzers, From A to AB: A Caucasian Mother with High Anti-B Titer Causing Hemolytic Disease of the Newborn, Intravenous Immunoglobulin-Associated Hemolytic Anemia, Clinical Laboratory Employees Attitudes Toward Artificial Intelligence. Tadesse H, Desta K, Kinde S, et al. [23]. Sources of errors in coagulation testing. This will facilitate speedy sample processing and report dispatch to the patients to initiate therapeutic interventions at the earliest. But there is long path to tread before we achieve 100% accuracy and precision. Hemolysis, which constituted the most frequent preanalytical error observed during sample processing of admitted patients, contributed to the rejection of 0.2% of the samples in OPD as compared to 1.1% in the previous case. 2007;45(6):708-11. doi: 10.1515/CCLM.2007.169. 2011;48:14353. Preanalytical errors have a significant impact on the quality of laboratory results and patient safety. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2004 Dec;37(12):1052-62. doi: 10.1016/j.clinbiochem.2004.08.009. Epub 2022 Aug 5. These data are comparable to those provided by other investigators, which confirm that problems directly related to specimen collection are the main cause of preanalytic errors, especially hemolyzed, clotted, insufficient, and incorrect samples.68, With the exclusive use of vacutainers, the frequency of errors found in our study is 1.5%. Your message has been successfully sent to your colleague. [11]. The majority of errors in TTP originate in the pre-analytical phase, being due to individual or system design defects. 2007;45(6): 712-719. The dependence on accurate laboratory results for diagnostics makes it mandatory for labs to ensure accountability and accuracy of results to negate incorrect diagnosis as a consequence of faulty reporting. Kalra J, Kopargaonkar A. 2022 Dec 19;4(1):294-7. doi: 10.1002/jha2.626. [5] The major source of errors in laboratories occurs in the preanalytical phase, with over 46% to 68%. An observational study conducted in 12 European countries by the European Federation of Clinical Chemistry and Laboratory Medicine reported unacceptably low compliance of phlebotomy procedures following the Clinical and Laboratory Standards Institute H3-A6 guidelines.[25]. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE). This may hamper proper sample collection, leading to inadequate collection. et al. "Pre-pre" and "post-post" analytical error: High-incidence patient 2004 Dec 1;88(3):161-81. doi: 10.1002/jso.20125. A number of recommendations have been issued [ 6 , 9 , 11 , 12 , 16 , 17 , 20 ]; detailed information can also be found in the RiliBK and DIN EN ISO 15189 (Chapter 36 and 38 ). Mehndiratta M, Pasha EH, Chandra N, Almeida EA. Pre- and post-analytical phases | SpringerLink However, few studies have examined the frequency of errors in laboratory test selection and interpretation. Online ahead of print. Detection of haemolysis, a frequent preanalytical problem in the serum of newborns and adults. The distribution of the various preanalytical variables is depicted in Table 2. [16]. "Pre-pre" and "post-post" analytical error: High-incidence patient safety hazards involving the clinical laboratory. government site. journal = "Clinical Chemistry and Laboratory Medicine". This leads to loss of precious time and is a labor-intensive activity. 2011;47:399408. An official website of the United States government. This constitutes an error rate of 1.2%. Clin Chem Lab Med. In 2014, the Spanish Society of Laboratory Medicine (SEQCML) started the current Preanalytical Phase EQA Programme, with the objective of providing a tool for the improvement of the preanalytical phase. Your documents are now available to view. Conceptualization: Jerold C. Alcantara, Khalid Alshaghdali, Bandar Alharbi. Background Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. An overall rate of 12.1% (6705) was determined as preanalytical errors. [4]. [20]. Nevertheless, it is mandatory for the laboratory staff to practice a certain basic level of workmanship and skillful phlebotomy techniques to reduce such errors to a minimum. Approval of the study protocol was obtained from the University of Hail, Research Ethics Committee (H-2021-247). It has been shown that pre-analytical errors are an inevitable source of laboratory errors and with regard to SARS-CoV-2 identification these factors are more significant , .Therefore, determination and optimizing these errors can entirely improve the analysis process and has a vital role in COVID-19 diagnosis. PDF Preanalytical Errors and their Impact on Tests in Clinical Laboratory [26,27] The foremost step in enhancing the quality of the preanalytical phase is to define potential errors and evaluate which errors pose a danger for the outcome of the patient. [9] In EDs, urgent and accurate test results are crucial, but due to workload pressures and various health care professionals involved, it increases the likelihood for preanalytical errors, including patient identification errors or mislabeling and inadequate mixing causing clotted samples.[10]. The site is secure. The findings of the present study provide a critical and valuable source of information that could systematically support quality management of the laboratory testing process to promote diagnostic excellence in the laboratory and patient care settings. Munoz [5]. Careers. 2018;64:10758. PLoS One. An increased occurrence of hemolyzed samples in the outpatient department was noted. Validation: Jerold C. Alcantara, Khalid Alshaghdali, Bandar Alharbi, Yasser Almotairi, Abdel Rahim Mahmoud Muddathir, Mohammad Jahoor Alam. This could be due to excessive patient load or lack of awareness regarding patient information. National Library of Medicine Am J Clin Pathol. The analysis of the overall distribution of errors revealed that 89.6% were pre-analytical errors, 2.6% were analytical, and 7.7% were post-analytical errors. Bookshelf Most errors are identified in pre-pre-analytic and post-post-analytic steps outside of the laboratory. Biochem Med (Zagreb). Lippi Quality improvement in clinical laboratories: a six sigma concept. Diagnostic algorithms providing guidance for test selection in specific disorders are also used as the basis for the establishment of reflex protocols in the clinical laboratory. [3]. Diagnostic algorithms providing guidance for test selection in specific disorders are also used as the basis for the establishment of reflex protocols in the clinical laboratory. You may be trying to access this site from a secured browser on the server. [7]. 2021 Jun;13(2):169-174. doi: 10.1055/s-0041-1729473. A total of 55,345 laboratory requests and samples from different departments and wards were evaluated for preanalytical errors. EJIFCC. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Errors arising during sample processing are classified into preanalytical, analytical, and post-analytical, depending upon their source and time of presentation respectively. The distribution of the different types of errors was then calculated (Table 1). 2022 Oct 1;32(3):030701. doi: 10.11613/BM.2022.030701. Aadil S, Vidyapeeth J. Although the causes of these errors are largely common to all laboratory medicine specialties, it is important for the haematology laboratory to understand the particular impact of some on automated counting. For this purpose, we have developed standard operating procedures (SOPs) for the different steps involved in ideal laboratory operations and ethics. Unauthorized use of these marks is strictly prohibited. An overall rate of 12.1% (6705) was determined as preanalytical errors. Questionnaire-based Study to Assess Knowledge of Preanalytical Phase of Laboratory Testing Among Trainee Doctors in a Tertiary Care Hospital Medical College. This will encourage managers, quality officers, and administrative leaders to participate or engage in quality monitoring systems and become more open to scrutiny and challenge. Generally, the pre . [7,15,16] Variation of the quality indicators used, sample acceptance and rejection criteria, length of the study periods, reporting and recording system, sample size, and laboratory facilities are factors that contribute to the disparity of results. The present study determined a rate of 12.1% of preanalytical errors from the total samples and laboratory requests received from the different departments. Zaini RG, Dahlawi HA, Siddiqi A. [19]. The introduction of vacuum tubes along with the closed system of blood collection has made blood collection efficient and easy. We will first discuss the findings of the routine samples obtained from the inpatients in our hospital. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. M P The occurrence of these errors was found to be highest in the emergency department (21%). PMC Accessibility The large ratio of laboratory errors in the preanalytical phase stems from the spectrum of variables, including patient variables, specimen collection variables, and specimen handling variables. Out of these 203 samples, laboratory personnel managed to ascertain correct patient data in 153 cases, and hence reporting was completed successfully for these patients. Pre-analytical errors: their impact and how to minimize them Keyword Highlighting The pre-and post-analytical phases of the process account for 93% of errors.1. It is a 600-bed hospital offering specialized medical and surgical treatment to about 300,000 patients in the outpatient department (OPD) and 19,000 patients in the general and private wards every year. In contrast, literature studies provide excellent evidence that EDs have a higher incidence of hemolysis than other wards or outpatient phlebotomy services. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. 2015 Feb;53(3):357-70. doi: 10.1515/cclm-2014-1051. However, the laboratory cannot function in isolation. Preanalytical quality improvement. [7] Similar studies also found that inappropriate sample containers, insufficient sample volume, specimen handling, storage, and transportation were among the common errors. Caffeic acid phenethyl ester analogues as selective inhibitors of 12-lipoxygenase product biosynthesis in human platelets. Dikmen ZG, Pinar A, Akbiyik F. Specimen rejection in laboratory medicine: necessary for patient safety? 2. FOIA F 2013 Apr 8;173(7):599]. Currently, pre-analytical errors account for up to 70% of all mistakes made in laboratory diagnostics, most of which arise from problems in patient preparation, sample collection, transportation, and preparation for analysis and storage. Hemolysis accounts for 40% to 70% of all rejected and unsuitable samples in clinical laboratories. A rare non-hemolytic case of idiopathic cold agglutinin disease. McCaughey EJ, Vecellio E, Lake R, et al. Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), https://psnet.ahrq.gov/web-mm/pre-analytical-pitfalls-missing-and-mislabeled-specimens, Analysis of preanalytical errors in a clinical chemistry laboratory: A 2-year study, Articles in PubMed by Jerold C. Alcantara, PhD, MT(ASCPI)SBBICM, RMT, Articles in Google Scholar by Jerold C. Alcantara, PhD, MT(ASCPI)SBBICM, RMT, Other articles in this journal by Jerold C. Alcantara, PhD, MT(ASCPI)SBBICM, RMT, Analysis of the clinical manifestations and 18F-FDG PET-CT findings in 40 patients with histiocytic necrotizing lymphadenitis, Diagnostic accuracy and value of chromosomal microarray analysis for chromosomal abnormalities in prenatal detection: A prospective clinical study, Clinical, laboratory, and imaging features of pediatric COVID-19: A systematic review and meta-analysis, Costs analysis of a training intervention for the reduction of preanalytical errors in primary care samples, Predictive value of serum uric acid levels for adverse perinatal outcomes in preeclampsia. Available at: [10]. Post-analytical laboratory work: national recommendations from the Compliance with good laboratory practices can significantly reduce the frequency of pre analytical errors. A P value of .05 was considered statistically significant. Challenges in Preanalytical Phase of Laboratory Medicine: Rate of Blood [12]. The frequency of hemolysis was more in the samples that were collected from the admitted patients as compared to the patients attending the OPDs (1.1% as compared to 0.2%). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Please enable it to take advantage of the complete set of features! BA The data collection procedure involved review of blood samples received from the inpatient as well as outpatient departments. Federal government websites often end in .gov or .mil. Vol. J Lab Physicians. automated cell counting; general haematology; postanalytical; preanalytical; quality indicators. 17579522 DOI: 10.1515/CCLM.2007.173 Abstract Data from recent studies suggest that the highest incidence of laboratory-related errors occurs in the pre-analytical phase of laboratory testing. Preanalytical Phase Errors: Experience of a Central Laboratory. Stumptner C, Stadlbauer V, O'Neil D, Gessner A, Hiergeist A, Zatloukal K, Abuja PM. Incomplete/wrong patient information makes the practice redundant. A practice of keeping a record of the errors at all stages of analysis and then devising corrective strategies for their prevention can gradually free a laboratory from such errors. Pre-treatment of rapamycin transformed M2 microglia alleviates traumatic cervical spinal cord injury via AIM2 signaling pathway in vitro and in vivo. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. Please enable scripts and reload this page. sharing sensitive information, make sure youre on a federal In a study of preanalytic errors, 47 percent of the errors were due to inadequate sample quality followed by wrong patient identification (26.8 percent), a missing physician order (14 percent), inappropriate sample quantity (11.6 percent), and inappropriate container (0.6 percent). HHS Vulnerability Disclosure, Help There was no focus on this error or data, but the decline can be credited to appropriate communication with the laboratory department, increase experience of staff, and proper orientation of test requisition system to new hospital staff. Quality Management of the Pre-Analytical Phase Errors: Monitoring and Supply chain disruptions due to the SARS-CoV-2 pandemic lead to an unusual preanalytical error in measuring hemoglobin concentration in a large medical center. Inpatient sampling with a frequency of 0.08% for inadequate volume only. Mounting evidence indicates that reliability cannot be achieved in a clinical laboratory through the mere promotion of accuracy in the analytical phase of the testing process. Meier Important errors can occur during the pre-analytic phase with specimen handling and identification. Clin Chem Lab Med. Data entry errors can arise when results are recorded and stored manually. Plebani M, Carraro P. Mistakes in a stat . [15]. 2020 Dec;12(3):178-183. doi: 10.1055/s-0040-1720945. A retrospective study of quality improvement in clinical biochemistry laboratory. Insufficient sample volume constituted the most frequent cause of test rejection in the samples collected in the OPD (0.37%). Tran NK, Liu Y. Pre-analytical pitfalls: missing and mislabeled specimens. Pract Lab Med. One of the most important factors in this step is capturing correct data. This phase may include specimen handling issues that occur even prior to the time the specimen is received in the laboratory. The promotion of ideal phlebotomy practices and sample transport procedures is a pre-requisite for the efficacy of laboratory functioning. 8600 Rockville Pike clinical chemistry; laboratory errors; preanalytical errors; Saudi Arabia. official website and that any information you provide is encrypted Please enable it to take advantage of the complete set of features! A quality initiative to decrease pathology specimen-labeling errors using radiofrequency identification in a high-volume endoscopy center.

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