Significant Reduction in Preanalytical Errors for Nonphlebotomy Blood Draws After Implementation of a Novel Integrated Specimen Collection Module

Lost, mislabeled, and mishandled surgical and clinical pathology specimens: A systematic review of published literature

OBJECTIVES

To perform a systematic review of published academic literature related to lost, mislabeled, and mishandled surgical and clinical pathology specimens during the preanalytical stage.

METHODS

The authors used Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to search PubMed, MEDLINE, Web of Science, and Scopus for relevant articles published from January 1, 1990, to May 1, 2023.

RESULTS

The authors screened 1313 articles and identified 44 peer-reviewed, English-language articles published between 1990 and 2021 for inclusion in the final systematic review. Most articles (n = 36) reported results from US-based facilities. Articles primarily focused on general clinical and general surgical pathology. Analysis of the articles revealed that articles reported a range of methodological approaches, including incident reports, implementation analyses, case studies, and commentary recommendations. Most articles focused on mislabeling errors (61.3%) and missing or lost specimens (18.2%), while several articles combined specimen errors (20.5%). Several implementation studies (22.7%) reported using multiple interventions to mitigate errors. Implementation efforts reported between 70% and 100% reduction in pathology errors.

CONCLUSIONS

The review highlights the limited research on the topic, with an average of 2 articles per year discussing lost, mislabeled, or mishandled specimens. Intervention studies addressed The Joint Commission's patient safety goals for laboratory practice. More research is needed about error incidents and reporting in non-Western countries to gain a more global perspective on the topic.

Direct costs of blood drawings with pre-analytical errors in tertiary paediatric hospital care

BACKGROUND

Blood drawings is a common hospital procedure involving laboratory and clinical disciplines that is important for the diagnosis and management of illnesses in children. Blood drawings with pre-analytical error (PAE) can lead to increased costs for hospitals and healthcare organisations. The direct cost of blood drawings after a PAE is not fully understood in paediatric hospital care.

AIM

The aim of this study was to estimate the average direct cost of PAE per year and per 10,000 blood drawings in tertiary paediatric care.

METHODS

A cost analysis using a bottom-up approach was conducted on the basis of combined information from the hospital's laboratory register for the period 2013-2014 and clinical in-ward observations at a tertiary children's referral hospital in Sweden, the Astrid Lindgren Children's Hospital. For the analysis, we hypothesised the re-collection of all blood drawings with PAE and included the average costs of the sampling materials, the time of the healthcare personnel, the laboratory analyses, and in-ward premises based on the time spent on the blood sampling procedure.

RESULTS

The annual cost of PAE was estimated to be 74,267 euros per 54,040 blood drawings, which corresponds to 13,756 euros per 10,000 blood drawings or 1.5 euros per draw. The personnel cost represented 60.1% (45,261 euros per year) of the cost due to PAE, followed by costs for hospitalisation (25.2%), laboratory analyses (8.1%), and materials (5.7%).

CONCLUSION

PAEs lead to substantial increases in the costs in tertiary paediatric hospital care. If these PAEs can be avoided, costs related to the re-collection of blood drawings with PAE may be re-allocated to other health-promoting activities for children visiting hospital institutions.

Preanalytical Errors in a Hematology Laboratory: An Experience from a Tertiary Care Center

BACKGROUND

Laboratory errors arise at any stage of testing. Detecting these inaccuracies before results are revealed might delay diagnosis and treatment, causing patient distress. Here, we studied the preanalytical errors in a hematology laboratory.

METHODS

This one-year retrospective analysis was conducted at the laboratory of a tertiary care hospital and included information on blood samples that were taken for hematology tests from both outpatients and inpatients. Laboratory records included sample collection and rejection information. The type and frequency of preanalytical errors were expressed as a proportion of total errors and sample number. Microsoft Excel was utilized to enter data. The results were presented in the form of frequency tables.

RESULTS

This research included 67,892 hematology samples. For preanalytical errors, 886 samples (1.3%) were discarded. The most common preanalytical error was insufficient sample (54.17%), and the least common was an empty/damaged tube (0.4%). Erroneous samples in the emergency department were mostly insufficient and clotted, whereas pediatric sample errors were caused by insufficient and diluted samples.

CONCLUSION

Inadequate samples and clotted samples account for the vast majority of preanalytical factors. Insufficiency and dilutional errors were most frequent from pediatric patients. Adherence to best laboratory practices can drastically cut down on preanalytical errors.

Results of using Luer-Lok access device for clinics, intensive care units, and emergency services with high pre-analytical errors: analysis of 491.850 samples

Objectives

The effectiveness of the Luer-Lok™ Access Device (LL) with the intravenous catheter (IVC) on sample rejections, which is used to prevent primarily hemolysis in the emergency department (ED), clinics, and intensive care units (ICU), was examined.

Methods

A total of 491.850 samples of eight months from Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital were investigated retrospectively. Inpatient, intensive care unit and emergency department samples were included in the study. Pre- (BLL) and post-Luer Lok (ALL) rejection of the samples analyzed. In the BLL period, 3,463 rejection samples out of 253,818 (1.36%) in the September-December period of 2020; in the ALL period, 1819 rejected samples from 238,032 (0.76%) in January-April 2021 were analyzed for all reasons.

Results

It was determined that the use of LL significantly reduced all-cause sample rejections. In addition, a significant decrease was observed in the rates of hemolysis and clot-related rejection thanks to LL.

Conclusions

According to our study data, in patients with IVC with the LL device, the pressure brought by the syringe is mainly avoided, and reliable blood collection is achieved, similar to the routine vacutainer blood collection apparatus, and hemolysis- and clot-related sample rejections are largely prevented.

Retrospective study showed that blood sampling errors risked children's well-being and safety in a Swedish paediatric tertiary care

AIM

Blood analyses containing preanalytical errors (PAEs) are hazardous for patients. This study investigated the frequency of PAEs in blood analysis and the corresponding quality indicators of the sampling process in Swedish paediatric tertiary care.

METHODS

Data were retrieved from the laboratory at Astrid Lindgren Children's Hospital between 2013 and 2014. Preanalytical blood sampling performance was analysed according to the Six Sigma scale, ranging from 0 to 6 (933 137-3.4 defects per million [DPM]).

RESULTS

Of the 1 148 716 analyses, 61 656 (5.4%) were rejected due to PAEs. The PAEs ranged between hospital specialities from 1.9 to 9.4% (p < 0.001) and work shift times, from 6.0% in the day to 5.7% in the evening and 4.3% at night (p values <0.001). Clotting was the most prominent error (51.3%), affecting mostly haematology and coagulation analyses. Incorrectly filled samples represented almost 25% of all PAEs, with effects on chemistry, haematology and coagulation analyses. The sigma score for the overall preanalytical phase (3.2) corresponded to 44 565 DPM.

CONCLUSION

Samples with PAEs were frequently clotted and insufficiently filled, and the distribution of errors varied within working shifts and specific analyses. The overall quality control in paediatric blood sampling was barely acceptable.