1
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Colak S, Tasdemir O, van der Schaaf M, Opdam F, van den Noort V, van den Broek D, van Rossum HH. Design, validation and performance of aspartate aminotransferase- and lactate dehydrogenase-reporting algorithms for haemolysed specimens including correction within quality specifications. Ann Clin Biochem 2024; 61:239-247. [PMID: 31495183 DOI: 10.1177/0004563219878475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In vitro haemolysis is a major operational challenge for medical laboratories. A new experimental design was used to investigate under what conditions algorithms could be designed to report either quantitative or qualitative aspartate aminotransferase and lactate dehydrogenase results outside the manufacturer's haemolysis specifications. Quantitative corrections were required to meet prespecified quality specifications. METHODS Twenty-five patient samples were used to design reporting algorithms and another 41 patient samples were used to validate the algorithms. Aspartate aminotransferase, lactate dehydrogenase and haemolysis index were determined using a Cobas 6000 analyser (Roche diagnostics, Mannheim, Germany). Correction factors were determined, and the accuracy of the correction was investigated. Reporting algorithms were designed based on (i) the manufacturer's cut-off for the haemolysis index, (ii) corrections within the total allowable error specification and (iii) qualitative reporting based on obtained results. The impact of the reporting algorithms was retrospectively determined by recalculating six months of aspartate aminotransferase and lactate dehydrogenase results. RESULTS No correction for aspartate aminotransferase/lactate dehydrogenase was possible for results below the upper reference interval limit, while results equal to or greater than the upper reference interval limit could, up to mild haemolysis, be corrected within the total error criterion. All samples generated from the validated patient cohort fulfilled the set criteria. The algorithms allowed reporting 88.5% and 85.9% of otherwise unreported aspartate aminotransferase and lactate dehydrogenase results, respectively. CONCLUSIONS An approach is presented that allows to generate and validate reporting algorithms for aspartate aminotransferase and lactate dehydrogenase compatible with prespecified quality specifications. The designed algorithms resulted in a significant reduction of otherwise unreported aspartate aminotransferase and lactate dehydrogenase results.
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Affiliation(s)
- Selcuk Colak
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Onur Tasdemir
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marianne van der Schaaf
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frans Opdam
- Division of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vincent van den Noort
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daan van den Broek
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Huub H van Rossum
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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2
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Flores E, Martínez-Racaj L, Torreblanca R, Blasco A, Lopez-Garrigós M, Gutiérrez I, Salinas M. Clinical Decision Support System in laboratory medicine. Clin Chem Lab Med 2024; 62:1277-1282. [PMID: 38044692 DOI: 10.1515/cclm-2023-1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
Clinical Decision Support Systems (CDSS) have been implemented in almost all healthcare settings. Laboratory medicine (LM), is one of the most important structured health data stores, but efforts are still needed to clarify the use and scope of these tools, especially in the laboratory setting. The aim is to clarify CDSS concept in LM, in the last decade. There is no consensus on the definition of CDSS in LM. A theoretical definition of CDSS in LM should capture the aim of driving significant improvements in LM mission, prevention, diagnosis, monitoring, and disease treatment. We identified the types, workflow and data sources of CDSS. The main applications of CDSS in LM were diagnostic support and clinical management, patient safety, workflow improvements, and cost containment. Laboratory professionals, with their expertise in quality improvement and quality assurance, have a chance to be leaders in CDSS.
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Affiliation(s)
- Emilio Flores
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, San Juan de Alicante, Spain
- Clinical Medicine Department, Universidad Miguel Hernandez, San Juan de Alicante, Spain
| | - Laura Martínez-Racaj
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, San Juan de Alicante, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Ruth Torreblanca
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, San Juan de Alicante, Spain
| | - Alvaro Blasco
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, San Juan de Alicante, Spain
| | - Maite Lopez-Garrigós
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, San Juan de Alicante, Spain
- Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain
| | - Irene Gutiérrez
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, San Juan de Alicante, Spain
| | - Maria Salinas
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, San Juan de Alicante, Spain
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3
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Tang Y, Gu R, Zhao Y, Wang J, Zhang Y, Li Q, Wang Z, Wang S, Wei Q, Wei L. Effectiveness of a Game-Based Mobile Application in Educating Nursing Students on Venous Blood Specimen Collection: A Randomized Controlled Trial. Games Health J 2023; 12:63-72. [PMID: 36413059 DOI: 10.1089/g4h.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Incorporating mobile applications into traditional clinical teaching methods to assess the impact of game-based mobile applications on the practical knowledge and skill levels of venous blood specimen collection among nursing students. Background: Although game-based mobile applications are recognized as teaching aids that replicate clinical practice in a safe environment, their impact and effectiveness are relatively unknown in the education of nursing students. Design: In September 2021, a single-blind randomized controlled trial was conducted in a university-affiliated hospital in China. Methods: One hundred five nursing students were randomly divided into the control group (n = 53) and the experimental group (n = 52). All participants received the same theoretical and operational training. For the next 7 days, the experimental group used a game-based mobile application, and the control group practiced venous blood specimen collection using traditional teaching methods. We observed the before-and-after comparison of the skill performance and learning curve of both groups of participants. Results: The final skill performance scores of the nursing students in the experimental group were higher than that of the nursing students in the control group (P < 0.001). Analysis of the learning curve showed that to master the skills, the experimental and control groups needed an average of 8 and 10 repetitions, respectively. Conclusion: This mobile application has a positive learning effect on nursing students' venous blood specimen collection skills in the short term. It should be applied to the training of clinical nursing skills.
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Affiliation(s)
- Yalin Tang
- School of Nursing, Qingdao University, Qingdao, China
| | - Ruting Gu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yafei Zhao
- School of Nursing, Qingdao University, Qingdao, China
| | - Jingyuan Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Zhang
- Department of Vasculocardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qianqian Li
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zihan Wang
- School of Nursing, Qingdao University, Qingdao, China
| | - Siyao Wang
- Cardiac Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiaofeng Wei
- Department of Nursing, Laixi Municipal Hospital, Qingdao, China
| | - Lili Wei
- Office of the Dean, The Affiliated Hospital of Qingdao University, Qingdao, China
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4
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Alonso-Sardón M, Sáez-Lorenzo M, Chamorro AJ, Fernández-Martín LC, Iglesias-de-Sena H, González-Núñez V, Santos-Sánchez JÁ, Carbonell C, Lorenzo-Gómez MF, Mirón-Canelo JA. Adverse Effects in Patients with Intellectual and Developmental Disabilities Hospitalized at the University Clinical Hospital. J Pers Med 2022; 12:1898. [PMID: 36422074 PMCID: PMC9698866 DOI: 10.3390/jpm12111898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/22/2022] [Accepted: 11/07/2022] [Indexed: 09/10/2024] Open
Abstract
(1) Background: Providing the patient with the health care they need in a personalized and appropriate manner and without adverse effects (AEs) is a part of quality of care and patient safety. The aim of this applied research project was the assessment of AEs as a clinical risk in patients with high social vulnerability such as persons with intellectual and developmental disabilities (PwIDD). (2) Methods: A retrospective epidemiological cohort study was performed on exposed and unexposed groups (the control group) in order to estimate the incidence of AEs in PwIDDs and assess their importance for this category of patients. (3) Results: AEs were observed with a frequency of 30.4% (95% CI) in the PwIDD exposed group, with significant differences to the unexposed group (p = 0.009). No differences were observed with regards to gender. Age was as a marker of care risk, with the highest incidence of AEs in the group of 60-69 years. (4) Conclusions: PwIDDs have a high risk of suffering AEs while receiving health care assistance due to their high social and clinical vulnerability. Health care practitioners must therefore be aware of these results and keep these observations in mind in order to carry out personalized, preventive, competent, effective, and safe medical care.
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Affiliation(s)
- Montserrat Alonso-Sardón
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - María Sáez-Lorenzo
- Pharmacological Treatments in Persons with Disabilities, School of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Antonio Javier Chamorro
- Disability and Prevalent Chronic Diseases, Adjunct of Internal Medicine, Faculty of Medicine, University Hospital of Salamanca (SACYL), 37008 Salamanca, Spain
| | - Luz Celia Fernández-Martín
- Expert in Social and Communication Skills in Persons with Disabilities, School of Phicology, University of Salamanca, 37008 Salamanca, Spain
| | - Helena Iglesias-de-Sena
- Pharmacological Treatments in Persons with Disabilities, School of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Verónica González-Núñez
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain
- Instituto de Neurociencias de Castilla y León (INCyL), University of Salamanca, 37008 Salamanca, Spain
| | - José Ángel Santos-Sánchez
- Specialist in Traumatology and Radiodiagnosis in Persons with Disabilities, School of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Cristina Carbonell
- Specialist in Infectious Diseases, Salamanca University Hospital, 37007 Salamanca, Spain
| | - María Fernanda Lorenzo-Gómez
- Disability and Incontinence, Faculty of Medicine, University of Salamanca Clinical Hospital (SACYL), 37007 Salamanca, Spain
| | - José Antonio Mirón-Canelo
- Preventive Medicine and Public Health, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
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5
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Romero-Arana A, Gómez-Salgado J, Fagundo-Rivera J, Cruz-Salgado Ó, Ortega-Moreno M, Romero-Martín M, Romero A. Compliance with the clinical laboratory quality protocol in public primary healthcare centres. Medicine (Baltimore) 2022; 101:e29095. [PMID: 35905269 PMCID: PMC9333548 DOI: 10.1097/md.0000000000029095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The clinical and economic relevance of the clinical laboratories procedures in Andalusia (Spain) have led the Regional Department of Health to focus attention on their improvement. A unified laboratory protocol was implemented that consisted of the unification of criteria in the handling and processing of samples, and report of results. The objective of this study is to describe the degree of compliance with the clinical laboratory protocol in the preanalytical phase, which includes the analytical request and up to the delivery in the laboratory, as well as the influencing factors. Cross-sectional descriptive study with a sample of 214 healthcare professionals involved in the preanalytical phase of laboratory procedures in primary care. A self-reported questionnaire with 11 items was used for data collection. Each item was assessed separately with a scale from 0 to 10. A 5 points score was considered as the cutoff point. Descriptive analysis was conducted and Mann-Whitney U test was used to determine differences between subgroups. Internal consistency of the questionnaire was considered. The best rated item was verifying the correspondence between the request form and identity of the patient. Each item scored from 3 to 10, and the mean for each item ranged from 6.40 (standard deviation = 3.06) to 8.57 (standard deviation = 2.00). Values above or equal to 8 were obtained, for 63.6% of them. Statistically significant differences between accredited and nonaccredited centres were found. Differences were not noteworthy regarding centres with a teaching activity or those without it. All the items were measured separately. The compliance with the protocol was adequate among primary healthcare professionals, who have a strategic position in the sample collection and its transport during the preanalytical phase. Being so, standardisation should be a priority to reduce errors and improve clinical safety and results.
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Affiliation(s)
- Adolfo Romero-Arana
- Andalusian Public Foundation for the Biomedical Research in Málaga (FIMABIS), Málaga, Spain
- Nursing Intensive Care Area, Hospital Regional Universitario, Málaga, Spain
| | - Juan Gómez-Salgado
- Faculty of Labour Sciences, Department of Sociology, Social Work and Public Health, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Program, Universidad Espíritu Santo, Samborondón, Guayaquil, Ecuador
- *Correspondence: Juan Gómez-Salgado, Faculty of Labour Sciences, Department of Sociology, Social Work and Public Health, University of Huelva, Avenida Tres de Marzo, s/n. Huelva 21007, Spain (e-mail: )
| | | | - Óscar Cruz-Salgado
- Quality board. Hospital Universitario Virgen Macarena, Andalusian Health Service, Sevilla, Spain
| | - Mónica Ortega-Moreno
- Faculty of Business Sciences, Department of Economy, University of Huelva, Huelva, Spain
| | | | - Adolfo Romero
- Nursing and Podiatry Department, Health Sciences School, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga 29071, Spain
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6
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Tola EK, Dabi YT, Dano GT. Assessment of Types and Frequency of Errors in Diagnostic Laboratories Among Selected Hospitals in East Wollega Zone, Oromia, Ethiopia. PATHOLOGY AND LABORATORY MEDICINE INTERNATIONAL 2022. [DOI: 10.2147/plmi.s351851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Costelloe SJ, Rico Rios N, Goulding N, Mistry H, Stretton A, De la Salle B, Hepburn S, Thomas A, Atherton J, Cornes M. A survey of practice in the management of haemolysis, icterus and lipaemia in blood specimens in the United Kingdom and Republic of Ireland. Ann Clin Biochem 2021; 59:222-233. [PMID: 34719993 DOI: 10.1177/00045632211059755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Haemolysis, icterus and lipaemia (HIL) are common interferants in laboratory medicine, potentially impacting patient care. This survey investigates HIL management in medical laboratories across the UK and Republic of Ireland (ROI). METHODS A survey was sent to members of key professional organisations for laboratory medicine in the UK and ROI. Questions related to the detection, monitoring, quality control, and management of HIL. RESULTS In total, responses from 124 laboratories were analysed, predominantly from England (52%) and ROI (36%). Most responses were from public hospitals with biochemistry services (90%), serving primary care (91%), inpatients (91%), and outpatients (89%). Most laboratories monitored H (98%), I (88%), and L (96%) using automated indices (93%), alone or in combination with visual inspection.Manufacturer-stated cut-offs were used by 83% and were applied to general chemistries in 79%, and immunoassays in 50%. Where HIL cut-offs are breached, 64% withheld results, while 96% reported interference to users. HIL were defined using numeric scales (70%) and ordinal scales (26%). HIL targets exist in 35% of laboratories, and 54% have attempted to reduce HIL. Internal Quality Control for HIL was lacking in 62% of laboratories, and just 18% of respondents have participated in External Quality Assurance. Laboratories agree manufacturers should: standardise HIL reporting (94%), ensure comparability between platforms (94%), and provide information on HIL cross-reactivity (99%). Respondents (99%) showed interest in evidence-based, standardised HIL cut-offs. CONCLUSIONS Most respondents monitor HIL, although the wide variation in practice may differentially affect clinical care. Laboratories seem receptive to education and advice on HIL management.
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Affiliation(s)
- Seán J Costelloe
- Department of Clinical Biochemistry, 57983Cork University Hospital, Cork, Republic of Ireland.,Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK
| | - Natividad Rico Rios
- Department of Clinical Biochemistry, 57983Cork University Hospital, Cork, Republic of Ireland
| | - Nicola Goulding
- Department of Clinical Biochemistry, 57983Cork University Hospital, Cork, Republic of Ireland
| | - Hema Mistry
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Serious Hazards of Transfusion Office, Manchester, UK
| | - Adam Stretton
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,6398Becton, Dickinson and Company, Wokingham, UK
| | - Barbara De la Salle
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,UK NEQAS Haematology, Watford, UK
| | - Sophie Hepburn
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Blood Sciences, 2592East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Annette Thomas
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Cardiff and Vale University Health Board, Cardiff, UK
| | - Jennifer Atherton
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Blood Sciences Department, Liverpool Clinical Laboratories, 4595Aintree University Hospital, Liverpool, UK
| | - Michael Cornes
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Biochemistry Department, 156747Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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8
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Hughes AEO, Jackups R. Clinical Decision Support for Laboratory Testing. Clin Chem 2021; 68:402-412. [PMID: 34871351 DOI: 10.1093/clinchem/hvab201] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND As technology enables new and increasingly complex laboratory tests, test utilization presents a growing challenge for healthcare systems. Clinical decision support (CDS) refers to digital tools that present providers with clinically relevant information and recommendations, which have been shown to improve test utilization. Nevertheless, individual CDS applications often fail, and implementation remains challenging. CONTENT We review common classes of CDS tools grounded in examples from the literature as well as our own institutional experience. In addition, we present a practical framework and specific recommendations for effective CDS implementation. SUMMARY CDS encompasses a rich set of tools that have the potential to drive significant improvements in laboratory testing, especially with respect to test utilization. Deploying CDS effectively requires thoughtful design and careful maintenance, and structured processes focused on quality improvement and change management play an important role in achieving these goals.
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Affiliation(s)
- Andrew E O Hughes
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ronald Jackups
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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9
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Kitchen S, Adcock DM, Dauer R, Kristoffersen AH, Lippi G, Mackie I, Marlar RA, Nair S. International Council for Standardization in Haematology (ICSH) recommendations for processing of blood samples for coagulation testing. Int J Lab Hematol 2021; 43:1272-1283. [PMID: 34581008 DOI: 10.1111/ijlh.13702] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/27/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
This guidance document has been prepared on behalf of the International Council for Standardization in Haematology (ICSH). The aim of the document is to provide guidance and recommendations for the processing of citrated blood samples for coagulation tests in clinical laboratories in all regions of the world. The following areas are included in this document: Sample transport including use of pneumatic tubes systems; clots in citrated samples; centrifugation; primary tube storage and stability; interfering substances including haemolysis, icterus and lipaemia; secondary aliquots-transport, storage and processing; preanalytical variables for platelet function testing. The following areas are excluded from this document, but are included in an associated ICSH document addressing collection of samples for coagulation tests in clinical laboratories; ordering tests; sample collection tube and anticoagulant; preparation of the patient; sample collection device; venous stasis before sample collection; order of draw when different sample types are collected; sample labelling; blood-to-anticoagulant ratio (tube filling); influence of haematocrit. The recommendations are based on published data in peer-reviewed literature and expert opinion.
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Affiliation(s)
- Steve Kitchen
- Sheffield Haemophilia and Thrombosis Centre, Sheffield, UK
| | - Dorothy M Adcock
- Laboratory Corporation of America Holdings, Burlington, North Carolina, USA
| | - Ray Dauer
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ann-Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Ian Mackie
- Research Department of Haematology, University College London, London, UK
| | - Richard A Marlar
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
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10
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Mueller L, Scherz V, Greub G, Jaton K, Opota O. Computer-Aided Medical Microbiology Monitoring Tool: A Strategy to Adapt to the SARS-CoV-2 Epidemic and That Highlights RT-PCR Consistency. Front Cell Infect Microbiol 2021; 11:594577. [PMID: 34589440 DOI: 10.1101/2020.07.27.20162123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/17/2021] [Indexed: 05/28/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic, important health and regulatory decisions relied on SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) results. Our diagnostic laboratory faced a rapid increase in the number of SARS-CoV-2 RT-PCR. To maintain a rapid turnaround time, we moved from a case-by-case validation of RT-PCR results to an automated validation and immediate results transmission to clinicians. A quality-monitoring tool based on a homemade algorithm coded in R was developed, to preserve high quality and to track aberrant results. We present the results of this quality-monitoring tool applied to 35,137 RT-PCR results. Patients tested several times led to 4,939 pairwise comparisons: 88% concordant and 12% discrepant. The algorithm automatically solved 428 out of 573 discrepancies. The most likely explanation for these 573 discrepancies was related for 44.9% of the situations to the clinical evolution of the disease, 27.9% to preanalytical factors, and 25.3% to stochasticity of the assay. Finally, 11 discrepant results could not be explained, including 8 for which clinical data was not available. For patients repeatedly tested on the same day, the second result confirmed a first negative or positive result in 99.2% or 88.9% of cases, respectively. The implemented quality-monitoring strategy allowed to: i) assist the investigation of discrepant results ii) focus the attention of medical microbiologists onto results requiring a specific expertise and iii) maintain an acceptable turnaround time. This work highlights the high RT-PCR consistency for the detection of SARS-CoV-2 and the necessity for automated processes to handle a huge number of microbiological results while preserving quality.
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Affiliation(s)
- Linda Mueller
- Insitute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentin Scherz
- Insitute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Insitute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katia Jaton
- Insitute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Onya Opota
- Insitute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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11
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Murthy V, Altawallbeh G, Rapp M, Senn C, Karger AB. Missed critical value callbacks due to middleware flaw. Clin Biochem 2021; 96:71-74. [PMID: 34324845 DOI: 10.1016/j.clinbiochem.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In 2018, our clinical laboratory was alerted to back-to-back plasma sodium critical value callback failures on the same patient, occurring on different shifts and involving different technologists. Therefore, we set forth to investigate the root cause for the critical value callback failures. DESIGN AND METHODS We conducted a thorough investigation focused on the processes associated with critical value identification and notification for plasma sodium measurement performed on the Siemens Vista. RESULTS Our investigation uncovered a flaw in the Siemens CentraLink middleware software. A default dark blue bar in the top row of the results review display was determined to obscure the red color which highlights critical values for lab staff identification. Sodium was disproportionately impacted by this flaw, as it is commonly ordered as part of metabolic panels, and is listed first among the panel analytes in the top row of the CentraLink display. Retrospective data review comparing critical callback failure rates for sodium to potassium and hemoglobin confirmed that sodium had significantly higher critical callback failure rates than these other analytes. After alerting the product manufacturer, Siemens programmed the CentraLink display so that the top row was blank and devoid of patient results, so that the blue color in the top row would no longer obscure the red visual cue of a patient's critical result. Sodium critical value callback failures were reduced to 0% after this middleware display correction. CONCLUSIONS Middleware design flaws can have unexpected consequences on clinical laboratory operations. We encourage clinical laboratories to closely examine user interfaces utilized by laboratory staff, and be wary of potential impacts that the display format may have on results reporting.
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Affiliation(s)
- Vishakantha Murthy
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Ghaith Altawallbeh
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Michael Rapp
- MHealth Fairview University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Christine Senn
- MHealth Fairview University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, United States.
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12
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Clinical Evaluation of the Torq Zero Delay Centrifuge System for Decentralized Blood Collection and Stabilization. Diagnostics (Basel) 2021; 11:diagnostics11061019. [PMID: 34199408 PMCID: PMC8226604 DOI: 10.3390/diagnostics11061019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/22/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Blood sample collection and rapid separation—critical preanalytical steps in clinical chemistry—can be challenging in decentralized collection settings. To address this gap, the Torq™ zero delay centrifuge system includes a lightweight, hand-portable centrifuge (ZDrive™) and a disc-shaped blood collection device (ZDisc™) enabling immediate sample centrifugation at the point of collection. Here, we report results from clinical validation studies comparing performance of the Torq System with a conventional plasma separation tube (PST). Blood specimens from 134 subjects were collected and processed across three independent sites to compare ZDisc and PST performance in the assessment of 14 analytes (K, Na, Cl, Ca, BUN, creatinine, AST, ALT, ALP, total bilirubin, albumin, total protein, cholesterol, and triglycerides). A 31-subject precision study was performed to evaluate reproducibility of plasma test results from ZDiscs, and plasma quality was assessed by measuring hemolysis and blood cells from 10 subject specimens. The ZDisc successfully collected and processed samples from 134 subjects. ZDisc results agreed with reference PSTs for all 14 analytes with mean % biases well below clinically significant levels. Results were reproducible across different operators and ZDisc production lots, and plasma blood cell counts and hemolysis levels fell well below clinical acceptance thresholds. ZDiscs produce plasma samples equivalent to reference PSTs. Results support the suitability of the Torq System for remotely collecting and processing blood samples in decentralized settings.
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Setya D, Pandey P, Ranjan S, Kumar D, Das S. Recapping error: A case of false positive result due to minuscule contamination by re-closure of vacutainer. INDIAN J PATHOL MICR 2020; 63:678-680. [PMID: 33154341 DOI: 10.4103/ijpm.ijpm_202_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Divya Setya
- Department of Transfusion Medicine, Jaypee Hospital, Sector 128, Noida, Gautam Buddh Nagar, Uttar Pradesh, India
| | - Prashant Pandey
- Department of Transfusion Medicine, Jaypee Hospital, Sector 128, Noida, Gautam Buddh Nagar, Uttar Pradesh, India
| | - Shweta Ranjan
- Department of Transfusion Medicine, Jaypee Hospital, Sector 128, Noida, Gautam Buddh Nagar, Uttar Pradesh, India
| | - Dharmender Kumar
- Department of Transfusion Medicine, Jaypee Hospital, Sector 128, Noida, Gautam Buddh Nagar, Uttar Pradesh, India
| | - Suryasnata Das
- Department of Laboratory Medicine, Jaypee Hospital, Sector 128, Noida, Gautam Buddh Nagar, Uttar Pradesh, India
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Kilinçarslan MG, Şahi N EM. Who repeats more laboratory tests inappropriately? Surgeons versus physicians. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 32:219-227. [PMID: 33044198 DOI: 10.3233/jrs-200065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inappropriate repeat testing is an objectively measurable type of health service overutilization which may harm patients. OBJECTIVE To evaluate both the frequency and cost of inappropriate repeat testing in a tertiary hospital in terms of specialties. METHODS This cross-sectional study was conducted in a tertiary hospital. Laboratory results of 26 tests ordered between 1 July 2014 and 30 June 2017 were evaluated retrospectively. Test that were repeated earlier than the minimum re-test interval were accepted as inappropriate repeat testing. After analyzing the descriptive statistics, the cluster analysis method was used to determine whether groups were formed within specialties. RESULTS Specialties form two clusters were found: the first cluster included specialties mostly from surgical science and the second cluster included specialties mostly from medical science. It was found that the cluster that includes mostly surgical specialties repeats laboratory tests at a higher rate but causes a waste of less resources, whereas the cluster that includes mostly medical specialties repeats laboratory tests at a lower rate but causes a waste of more resources due to a higher volume of test orders. CONCLUSION Due to the high rates of inappropriate repeat testing, surgical specialties seem to be the first target of intervention strategies, but medical specialties, which account for a higher volume of inappropriate repeat testing and higher unnecessary cost, should be the primary target of intervention strategies.
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Affiliation(s)
| | - Erkan Melih Şahi N
- Department of Family Medicine, University of Canakkale Onsekiz Mart, Canakkale, Turkey
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15
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Paal M, Habler K, Vogeser M. Mass spectrometric sample identification with indicator compounds introduced via labeled sample tubes. Clin Chem Lab Med 2020; 59:147-154. [PMID: 32716904 DOI: 10.1515/cclm-2020-0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/04/2020] [Indexed: 11/15/2022]
Abstract
Objectives The risk of sample confusion continues to be a challenge for the pre-analytical part of the overall testing process. We here describe a novel system to track samples based on a chemical code labeling of test tubes with unique combinations of indicator compounds, which are naturally not present in specimens of human origin. As part of the sample vessel filling, the liquid specimens are permanently labeled with the compound code that can be tracked back to the primary tube. Methods As a proof of concept we used 10 stable-isotope-labeled derivates of medical drugs as indicator substances to create a combinatory 10-digit binary number ID for individual test tubes, i.e. presence/absence of the respective compound. For this purpose, combinations of indicator compounds were provided in evaporated form in polypropylene tubes prior to filling with anonymized patient whole blood and corresponding plasmas subjected to liquid chromatography tandem-mass spectrometry designed to detect the 10 indicator compounds. Results In the blind analysis, we correctly identified 307 different whole blood samples by readout of a 10-digit binary number ID based on the detection of indicator compounds with respect to their presence and number. Conclusions We have demonstrated the feasibility of an internal labeling procedure for diagnostic samples with mass spectrometry-based readout of dissolved indicator compound combinations as a binary number ID. With an increasing number of coding compounds (≫10) a vast number of combinations for sample labeling can be realized beyond the proof of concept setting studied herein.
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Affiliation(s)
- Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Katharina Habler
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
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Arul P, Pushparaj M, Pandian K, Chennimalai L, Rajendran K, Selvaraj E, Masilamani S. Prevalence and types of preanalytical error in hematology laboratory of a tertiary care hospital in South India. J Lab Physicians 2020; 10:237-240. [PMID: 29692594 PMCID: PMC5896195 DOI: 10.4103/jlp.jlp_98_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An important component of laboratory medicine is preanalytical phase. Since laboratory report plays a major role in patient management, more importance should be given to the quality of laboratory tests. AIM The present study was undertaken to find the prevalence and types of preanalytical errors at a tertiary care hospital in South India. MATERIALS AND METHODS In this cross-sectional study, a total of 118,732 samples ([62,474 outpatient department [OPD] and 56,258 inpatient department [IPD]) were received in hematology laboratory. These samples were analyzed for preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples. RESULTS The overall prevalence of preanalytical errors found was 513 samples, which is 0.43% of the total number of samples received. The most common preanalytical error observed was inadequate samples followed by clotted samples. Overall frequencies (both OPD and IPD) of preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples were 0.02%, 0.05%, 0.2%, 0.12%, 0.02%, and 0.03%, respectively. CONCLUSION The present study concluded that incorrect phlebotomy techniques due to lack of awareness is the main reason for preanalytical errors. This can be avoided by proper communication and coordination between laboratory and wards, proper training and continuing medical education programs for laboratory and paramedical staffs, and knowledge of the intervening factors that can influence laboratory results.
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Affiliation(s)
- Pitchaikaran Arul
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Magesh Pushparaj
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Kanmani Pandian
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Lingasamy Chennimalai
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Karthika Rajendran
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Eniya Selvaraj
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Suresh Masilamani
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
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Desalegn DM, Taddese BD, Yemanebrhane N, Getahun MS, Kitila KT, Dinku TT, Asferie KD, Wolde EA, Tura GB, Mersha TB, Rorissa AW, Wondimagegnehu DD, Hailu TK, Bika AT. Medical laboratory accreditation in a resource-limited district health centre laboratory, Addis Ababa, Ethiopia. Afr J Lab Med 2019; 8:793. [PMID: 31616618 PMCID: PMC6779986 DOI: 10.4102/ajlm.v8i1.793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/05/2019] [Indexed: 11/23/2022] Open
Abstract
Background Improving the quality of medical laboratory services is a high priority in many countries. However, quality management systems for laboratories in resource-limited settings are often inadequate. Objectives This article shares the experiences, benefits and challenges of the laboratory journey towards accreditation in a primary healthcare laboratory in Addis Ababa, Ethiopia. Methods A retrospective review of laboratory records in Addis Ketema Health Center was conducted from 2012 to 2015. The study was supplemented by observations from some of the authors of this article who worked in the laboratory. Results The laboratory journey towards accreditation began with a baseline assessment in 2012 using the World Health Organization African Region Stepwise Laboratory Quality Improvement Process Towards Accreditation; the baseline score was 78 points (0 stars). After mentorship support, the laboratory improved to 198 points (3 stars) in 2013 and 249 points (5 stars) in 2014. The laboratory scaled up to International Organization for Standardization 15189 requirements and received limited-scope accreditation for tuberculosis sputum microscopy and hematology tests in 2015. After adopting and implementing the standards, steady improvement was observed in the reliability of the laboratory services. Lack of resources was the major challenge the laboratory encountered. Conclusion Even though a remarkable quality performance improvement was observed over the entire process, inadequate skilled personnel was the major challenge identified in the road towards accreditation. Therefore, an appropriate, workload-based staffing structure should be developed to improve and sustain medical laboratory quality standards in resource-limited settings.
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Affiliation(s)
- Daniel M Desalegn
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia.,Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia.,Addis Ketema District Health Center Laboratory, Addis Ketema, Addis Ababa, Ethiopia
| | - Boja D Taddese
- Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | | | - Mulye S Getahun
- Addis Ketema District Health Center Laboratory, Addis Ketema, Addis Ababa, Ethiopia
| | - Kumera T Kitila
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia.,Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Tariku T Dinku
- Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Kassahun D Asferie
- Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Elizabeth A Wolde
- Addis Ketema District Health Center Laboratory, Addis Ketema, Addis Ababa, Ethiopia
| | - Gemechis B Tura
- Addis Ketema District Health Center Laboratory, Addis Ketema, Addis Ababa, Ethiopia
| | - Tilahun B Mersha
- Addis Ketema District Health Center Laboratory, Addis Ketema, Addis Ababa, Ethiopia
| | - Alemayhu W Rorissa
- Addis Ketema District Health Center Laboratory, Addis Ketema, Addis Ababa, Ethiopia
| | | | - Tinsae K Hailu
- Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Abrham T Bika
- Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
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Sua LF, Amézquita MA, Hernández DE, Alcalá-Flores M, Leib CS, Aguirre-Rojas M, Fernández-Trujillo L. Estaciones automatizadas preanalíticas en el laboratorio de hemostasia. Estudio observacional descriptivo prospectivo, realizado en un hospital universitario de referencia entre el 15 de abril y 15 de julio de 2017. IATREIA 2019. [DOI: 10.17533/udea.iatreia.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: los errores del proceso de análisis de las muestras del laboratorio clínico, impactan negativamente a la práctica médica, la seguridad del paciente e incrementan los costos de atención en la salud. El uso de estaciones automatizadas demostró una disminución de los errores en los laboratorios clínicos de inmunoquímica y hematología. Se propone comparar las primeras estaciones automatizadas de hemostasia con el método manual para determinar los interferentes en las muestras de cinco servicios del hospital durante tres meses.Métodos: estudio observacional descriptivo prospectivo de corte trasversal. Las muestras que ingresaron al laboratorio clínico fueron analizadas por la estación automatizada y el método manual. Las interferentes bilirrubinas, hemoglobina, lipemia, volumen de llenado del tubo y obstrucción fluídica-coágulo se estudiaron con ambos métodos. Se realizó el análisis estadístico y se calculó el índice kappa para determinar la fuerza de la concordancia entre los métodos.Resultados: de 8.970 muestras analizadas, 29 % provinieron del servicio de urgencias. Las muestras aportadas por la unidad de cuidado intensivo reportaron más interferentes con ambos métodos; la estación automatizada reportó más interferentes que el método manual, con un índice kappa 0,52; la bilirrubina fue el interferente más detectado por ambos métodos. El método manual no evidenció el interferente volumen de llenado del tubo ni obstrucción fluídica-coágulo, los cuales fueron detectados por la estación automatizada.Conclusiones: la estación automatizada detectó más interferentes en comparación con el método manual. Los interferentes son errores preanalíticos en el laboratorio de hemostasia y son detectados con poca frecuencia de forma visual, especialmente los interferentes volúmenes de llenado del tubo y obstrucción fluídica-coágulo.
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Lee NY. Reduction of pre-analytical errors in the clinical laboratory at the University Hospital of Korea through quality improvement activities. Clin Biochem 2019; 70:24-29. [PMID: 31153900 DOI: 10.1016/j.clinbiochem.2019.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The clinical laboratory is responsible for reporting accurate and expeditious results. However, the pre-analytical phase is directly related to the procedure of specimen collection and is mostly out of the direct control of the laboratory; further, most pre-analytical errors are related to human factors. Therefore, education and training programs for the phlebotomy teams are considered the most significant and necessary measures to reduce these errors. METHODS A cross-sectional study was conducted to investigate the types and frequencies of pre-analytical errors in the hospital laboratory. Pre-analytical errors were categorized into four main categories: rejected sample, error related to test ordering, misidentification, and others. Several activities were performed for quality improvement in order to reduce the rates of these errors. The data were analyzed by comparing the pre-intervention and post-intervention results along with the results of questionnaires to assess knowledge to investigate the effects of the activities. RESULTS The rates of pre-analytical errors decreased from 0.42% in the pre-intervention period to 0.32% in the post-intervention period. The rejected sample category accounted for the highest rates in the pre- and post-intervention periods. In the questionnaires, the overall average score after the intervention was 71.5, which was a significant increase from 46.0 in the pre-intervention period. CONCLUSIONS Each clinical laboratory has various types of pre-analytical errors due to the complexity of the healthcare environment. Therefore, targeted intervention including a quality improvement program and its continuous maintenance should be conducted to reduce pre-analytical errors and to improve patient safety.
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Affiliation(s)
- Nan Young Lee
- Department of laboratory medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.
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20
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Cornes M, Ibarz M, Ivanov H, Grankvist K. Blood sampling guidelines with focus on patient safety and identification – a review. Diagnosis (Berl) 2018; 6:33-37. [DOI: 10.1515/dx-2018-0042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
Abstract
It has been well documented over recent years that the preanalytical phase is a leading contributor to errors in the total testing process (TTP). There has however been great progress made in recent years due to the exponential growth of working groups specialising in the field. Patient safety is clearly at the forefront of any healthcare system and any reduction in errors at any stage will improve patient safety. Venous blood collection is a key step in the TTP, and here we review the key errors that occur in venous phlebotomy process and summarise the evidence around their significance to patient safety. Recent studies have identified that patient identification and tube labelling are the steps that carry the highest risk with regard to patient safety. Other studies have shown that in 16.1% of cases, patient identification is incorrectly performed and that 56% of patient identification errors are due to poor labelling practice. We recommend that patient identification must be done using open questions and ideally three separate pieces of information. Labelling of the tube or linking the identity of the patient to the tube label electronically must be done in the presence of the patient whether it is before or after sampling. Combined this will minimise any chance of patient misidentification.
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Affiliation(s)
- Michael Cornes
- Clinical Chemistry Department , Worcester Acute Hospitals NHS Trust , Worcester , UK , Phone: +44-1905-760843
| | - Mercedes Ibarz
- Laboratory Medicine Department , University Hospital Arnau de Vilanova, IRBLleida , Lleida , Spain
| | | | - Kjell Grankvist
- Department of Medical Biosciences , Clinical Chemistry, Umeå University , Umea , Sweden
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21
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Standardization of sampling and sample preparation for analysis of human monocyte subsets in peripheral blood. J Immunol Methods 2018; 461:53-62. [DOI: 10.1016/j.jim.2018.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/09/2018] [Accepted: 06/06/2018] [Indexed: 02/06/2023]
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22
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Jacobsen KK, Brandt I, Christensen AV, Rimsø BA, Krøier CJ, Sørensen M, Smith J, Jensen KOF, Larsen JM. Order of draw practices in venous blood sampling at clinical biochemistry departments in the Danish health care system. Clin Biochem 2018; 56:113-116. [PMID: 29684368 DOI: 10.1016/j.clinbiochem.2018.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Deviation in blood collection procedures is a central source of preanalytical variation affecting overall analytical and diagnostic precision. The order of draw of venous sampling is suspected to affect analytical results, in particular for coagulation analysis. Here we compare the procedures in venous blood sampling among clinical biochemistry departments to assess the uniformity of order of blood draw and adherence to international guidelines in the Danish health care system. METHODS We collected venous order of draw procedures from 49 clinical biochemistry departments at 22 public hospitals in Denmark. Procedures were compared to the international guidelines fromthe Clinical Laboratory Standards Institute (CLSI) and World Health Organization (WHO), and assessed in relation to department ISO 15189:2012 accreditation. RESULTS We observed seven different order of draw procedures related to citrate, serum, heparin, and EDTA tubes, and the use of discard tubes in relation to coagulation assays. 31 departments (63.3%) were found to adhere to CLSI and WHO guidelines. A majority of departments instructs the use of discard tubes before collection for coagulation assays in citrate tubes (44 departments; 89.8%). The citrate tube was the first sample tube to be drawn for most departments (35 departments; 75.5%); and the preferred order of non-citrate tubes was serum-heparin-EDTA (36 departments; 73.5%). Adherence to the CLSI and WHO guidelines was not associated with department ISO 15189:2012 accreditation (p = .57). CONCLUSIONS Venous order of draw procedures is diverse at Danish clinical biochemistry departments and show moderate adherence to international guidelines.
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Affiliation(s)
- Katja Kemp Jacobsen
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark.
| | - Ida Brandt
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Anne Vindahl Christensen
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Bjørk Anine Rimsø
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Camilla Julie Krøier
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Michelle Sørensen
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Julie Smith
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | | | - Jeppe Madura Larsen
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark; National Food Institute, Technical University of Denmark, Lyngby, Denmark
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Kamlage B, Neuber S, Bethan B, González Maldonado S, Wagner-Golbs A, Peter E, Schmitz O, Schatz P. Impact of Prolonged Blood Incubation and Extended Serum Storage at Room Temperature on the Human Serum Metabolome. Metabolites 2018; 8:metabo8010006. [PMID: 29342854 PMCID: PMC5875996 DOI: 10.3390/metabo8010006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023] Open
Abstract
Metabolomics is a powerful technology with broad applications in life science that, like other -omics approaches, requires high-quality samples to achieve reliable results and ensure reproducibility. Therefore, along with quality assurance, methods to assess sample quality regarding pre-analytical confounders are urgently needed. In this study, we analyzed the response of the human serum metabolome to pre-analytical variations comprising prolonged blood incubation and extended serum storage at room temperature by using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) -based metabolomics. We found that the prolonged incubation of blood results in a statistically significant 20% increase and 4% decrease of 225 tested serum metabolites. Extended serum storage affected 21% of the analyzed metabolites (14% increased, 7% decreased). Amino acids and nucleobases showed the highest percentage of changed metabolites in both confounding conditions, whereas lipids were remarkably stable. Interestingly, the amounts of taurine and O-phosphoethanolamine, which have both been discussed as biomarkers for various diseases, were 1.8- and 2.9-fold increased after 6 h of blood incubation. Since we found that both are more stable in ethylenediaminetetraacetic acid (EDTA) blood, EDTA plasma should be the preferred metabolomics matrix.
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Affiliation(s)
- Beate Kamlage
- Metanomics Health GmbH, Tegeler Weg 33, 10589 Berlin, Germany.
| | | | - Bianca Bethan
- Metanomics Health GmbH, Tegeler Weg 33, 10589 Berlin, Germany.
| | | | | | - Erik Peter
- Metanomics Health GmbH, Tegeler Weg 33, 10589 Berlin, Germany.
| | | | - Philipp Schatz
- Metanomics Health GmbH, Tegeler Weg 33, 10589 Berlin, Germany.
- Precision Medicine Unit, Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, 43183 Mölndal, Gothenburg, Sweden.
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Haid M, Muschet C, Wahl S, Römisch-Margl W, Prehn C, Möller G, Adamski J. Long-Term Stability of Human Plasma Metabolites during Storage at -80 °C. J Proteome Res 2017; 17:203-211. [PMID: 29064256 DOI: 10.1021/acs.jproteome.7b00518] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Prolonged storage of biospecimen can lead to artificially altered metabolite concentrations and thus bias data analysis in metabolomics experiments. To elucidate the potential impact of long-term storage on the metabolite profile, a pooled human plasma sample was aliquoted and stored at -80 °C. During a time period of five years, 1012 of the aliquots were measured with the Biocrates AbsoluteIDQ p180 targeted-metabolomics assay at 193 time points. Modeling the concentration courses over time revealed that 55 out of 111 metabolites remained stable. The statistically significantly changed metabolites showed on average an increase or decrease of +13.7% or -14.5%, respectively. In detail, increased concentration levels were observed for amino acids (mean: + 15.4%), the sum of hexoses (+7.9%), butyrylcarnitine (+9.4%), and some phospholipids mostly with chain lengths exceeding 40 carbon atoms (mean: +18.0%). Lipids tended to exhibit decreased concentration levels with the following mean concentration changes: acylcarnitines, -12.1%; lysophosphatidylcholines, -15.1%; diacyl-phosphatidylcholines, -17.0%; acyl-alkyl-phosphatidylcholines, -13.3%; sphingomyelins, -14.8%. We conclude that storage of plasma samples at -80 °C for up to five years can lead to altered concentration levels of amino acids, acylcarnitines, glycerophospholipids, sphingomyelins, and the sum of hexoses. These alterations must be considered when analyzing metabolomics data from long-term epidemiological studies.
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Affiliation(s)
| | | | | | | | | | | | - Jerzy Adamski
- Lehrstuhl für Experimentelle Genetik, Technische Universität München , 85350 Freising-Weihenstephan, Germany.,German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
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Scherz V, Durussel C, Greub G. Internal quality assurance in diagnostic microbiology: A simple approach for insightful data. PLoS One 2017; 12:e0187263. [PMID: 29135992 PMCID: PMC5685576 DOI: 10.1371/journal.pone.0187263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022] Open
Abstract
Given the importance of microbiology results on patient care, high quality standards are expected. Internal quality assurance (IQA) could mitigate the limitations of internal quality control, competency assessment and external quality assurance, adding a longitudinal insight, including pre- and post-analytical steps. Here, we implemented an IQA program in our clinical microbiology facilities with blind resubmission of routine samples during 22 months. One-hundred-and-twenty-one out of 123 (98.4%) serological analyses and 112 out of 122 (91.8%) molecular analyses were concordant. Among the discordances in molecular biology analyses, 6 results were low positive samples that turned out negative, likely due to stochastic repartition of nucleic acids. Moreover, one identified retranscription error led us to implement automated results transmission from the Applied Biosystems instruments to the laboratory information system (LIS). Regarding Gram stain microscopy, 560 out of 745 (75.2%) of compared parameters were concordant. As many as 67 out of 84 (79.8%) pairs of culture results were similar, including 16 sterile pairs, 27 having identical identification or description and semi-quantification and 24 only showing variations in semi-quantification with identical description or identification of colonies. Seventeen pairs had diverging identification or description of colonies. Culture was twice only done for one member of the pairs. Regarding antibiotic susceptibility testing, a major discrepancy was observed in 5 out of 48 results (10.4%). In conclusion, serological tests were highly reproducible. Molecular diagnosis also revealed to be robust except when the amounts of nucleic acids present in the sample were close to the limits of detection. Conventional microbiology was less robust with major discrepancies reaching 39.5% of the samples for microscopy. Similarly, culture and antibiotic susceptibility testing were prone to discrepancies. This work was ground for reconsidering multiples aspects of our practices and demonstrates the importance of IQA to complete the other quality management procedures.
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Affiliation(s)
- Valentin Scherz
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - Christian Durussel
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
- * E-mail:
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Mansouri S, D'Orazio P, Ehrmeyer S. A critical appraisal of a methodology for estimating analytical variation from sequential patient blood gas measurements. Clin Biochem 2017; 50:1330-1331. [PMID: 28782522 DOI: 10.1016/j.clinbiochem.2017.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/17/2017] [Accepted: 07/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sohrab Mansouri
- Instrumentation Laboratory, 180 Hartwell Road, Bedford, MA 01730, United States.
| | - Paul D'Orazio
- Chemical Sensing Consultant, 525 Old Harvard Road, Boxborough, MA 01719, United States
| | - Sharon Ehrmeyer
- Pathology and Laboratory Medicine, University of Wisconsin-Madison, 7109 Park Shores Court, Middleton, WI 53562, United States
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Nilsson K, Brulin C, Grankvist K, Juthberg C. Factors associated with nursing students' adherence to venous blood collection practice guidelines - A cross sectional study. Nurse Educ Pract 2017; 23:92-98. [PMID: 28278444 DOI: 10.1016/j.nepr.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 05/25/2016] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
Abstract
Venous blood specimen collection is a common procedure that nursing students perform during pre-registration courses, and training for such collections takes place on campus as well as at clinical placements. However, levels of adherence to practice guidelines are still suboptimal among both nursing students and healthcare staff. We aimed to explore nursing students' adherence to the Swedish national venous blood specimen collection practice guidelines regarding patient identification and test request management and how this adherence is related to clinical experience, capability beliefs, research use, and the perceived social climate in clinical contexts. A survey with a cross-sectional design was conducted among 305 nursing students at a medium-sized university in Sweden. Descriptive statistics and logistic regression were used for data analysis. The survey showed that 82% of the students adhered to patient identification guideline practices and 80% to test request management practices. Factors associated with correct patient identification procedures were semester and frequency of research use. Factors associated with correct test request management were previous healthcare work experience, semester, and capability beliefs regarding academic abilities and evidence-based practice. We conclude that there is a need to develop educational tools to train students in research use and evidence-based practice in order to enhance guideline practice adherence and improve patient safety.
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Affiliation(s)
- Karin Nilsson
- Department of Nursing, Umeå University, S-901 87 Umeå, Sweden.
| | | | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, S-901 85 Umeå, Sweden
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Cornes M, van Dongen-Lases E, Grankvist K, Ibarz M, Kristensen G, Lippi G, Nybo M, Simundic AM. Order of blood draw: Opinion Paper by the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE). ACTA ACUST UNITED AC 2017; 55:27-31. [DOI: 10.1515/cclm-2016-0426] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/21/2016] [Indexed: 11/15/2022]
Abstract
AbstractIt has been well reported over recent years that most errors within the total testing process occur in the pre-analytical phase (46%–68.2%), an area that is usually outside of the direct control of the laboratory and which includes sample collection (phlebotomy). National and international (WHO, CLSI) guidelines recommend that the order of draw of blood during phlebotomy should be blood culture/sterile tubes, then plain tubes/gel tubes, then tubes containing additives. This prevents contamination of sample tubes with additives from previous tubes that could cause erroneous results. There have been a number of studies recently looking at whether order of draw remains a problem with modern phlebotomy techniques and materials, or it is an outdated practice followed simply because of historical reasons. In the following article, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Preanalytical Phase (EFLM WG-PRE) provides an overview and summary of the literature with regards to order of draw in venous blood collection. Given the evidence presented in this article, the EFLM WG-PRE herein concludes that a significant frequency of sample contamination does occur if order of draw is not followed during blood collection and when performing venipuncture under less than ideal circumstances, thus putting patient safety at risk. Moreover, given that order of draw is not difficult to follow and knowing that ideal phlebotomy conditions and protocols are not always followed or possible, EFLM WG-PRE supports the continued recommendation of ensuring a correct order of draw for venous blood collection.
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West J, Atherton J, Costelloe SJ, Pourmahram G, Stretton A, Cornes M. Preanalytical errors in medical laboratories: a review of the available methodologies of data collection and analysis. Ann Clin Biochem 2016; 54:14-19. [DOI: 10.1177/0004563216669384] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preanalytical errors have previously been shown to contribute a significant proportion of errors in laboratory processes and contribute to a number of patient safety risks. Accreditation against ISO 15189:2012 requires that laboratory Quality Management Systems consider the impact of preanalytical processes in areas such as the identification and control of non-conformances, continual improvement, internal audit and quality indicators. Previous studies have shown that there is a wide variation in the definition, repertoire and collection methods for preanalytical quality indicators. The International Federation of Clinical Chemistry Working Group on Laboratory Errors and Patient Safety has defined a number of quality indicators for the preanalytical stage, and the adoption of harmonized definitions will support interlaboratory comparisons and continual improvement. There are a variety of data collection methods, including audit, manual recording processes, incident reporting mechanisms and laboratory information systems. Quality management processes such as benchmarking, statistical process control, Pareto analysis and failure mode and effect analysis can be used to review data and should be incorporated into clinical governance mechanisms. In this paper, The Association for Clinical Biochemistry and Laboratory Medicine PreAnalytical Specialist Interest Group review the various data collection methods available. Our recommendation is the use of the laboratory information management systems as a recording mechanism for preanalytical errors as this provides the easiest and most standardized mechanism of data capture.
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Affiliation(s)
- Jamie West
- Department of Clinical Biochemistry and Immunology, Peterborough City Hospital, Peterborough, UK
| | - Jennifer Atherton
- Liverpool Clinical Laboratories, Blood Sciences Department, Aintree University Hospital, Liverpool, UK
| | - Seán J Costelloe
- Derriford Combined Laboratory, Plymouth Hospitals NHS Trust, Plymouth, Devon, UK
| | | | - Adam Stretton
- Becton Dickinson Diagnostics, Preanalytical Systems (PAS), Oxford, UK
| | - Michael Cornes
- Clinical Chemistry Department, New Cross Hospital, Wolverhampton, UK
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Abstract
OBJECTIVES To describe the types and severity of reported laboratory errors in pediatric emergency departments. METHODS Retrospective review of incident reports classified as laboratory errors from July 2007 to June 2008 within the Pediatric Emergency Care Applied Research Network. Laboratory testing errors recorded included: delayed results or lost specimen, unlabeled specimens, wrong patient, failure to label specimen correctly, and other. The severity of laboratory-related incidents was characterized using the National Coordinating Council for Medication Error Reporting and Prevention severity classification system. Contributing factors were classified as environmental, equipment, human (employee), information technology systems, parent or guardian, or systems-based. RESULTS A total of 335 (42.2%) laboratory reports were related to events in the preanalytic phase. Involved staff personnel were identified in 345 of the reports (43.5%). Nurses were identified in 179 (22.6%) and physicians in 38 (4.8%). The majority of laboratory errors [408 (51.5%)] were not associated with harm; 138 (17.4%) patients were harmed by the error; 136 (98.6%) patients were temporarily harmed and required treatment, and 1 (0.7%) patient was hospitalized or had their hospitalization prolonged with the event. Human factors 657 (82.8%) were the most common contributing factor. CONCLUSIONS Laboratory errors are a common cause of safety events in the pediatric ED. Most events are preanalytic and involve problems with specimens that are improperly collected, mislabeled, or lost. Although most events were not associated with harm, there is potential for significant injury.
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Erdal EP, Mitra D, Khangulov VS, Church S, Plokhoy E. The economic impact of poor sample quality in clinical chemistry laboratories: results from a global survey. Ann Clin Biochem 2016; 54:230-239. [PMID: 27166314 DOI: 10.1177/0004563216651647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Despite advances in clinical chemistry testing, poor blood sample quality continues to impact laboratory operations and the quality of results. While previous studies have identified the preanalytical causes of lower sample quality, few studies have examined the economic impact of poor sample quality on the laboratory. Specifically, the costs associated with workarounds related to fibrin and gel contaminants remain largely unexplored. Methods A quantitative survey of clinical chemistry laboratory stakeholders across 10 international regions, including countries in North America, Europe and Oceania, was conducted to examine current blood sample testing practices, sample quality issues and practices to remediate poor sample quality. Survey data were used to estimate costs incurred by laboratories to mitigate sample quality issues. Results Responses from 164 participants were included in the analysis, which was focused on three specific issues: fibrin strands, fibrin masses and gel globules. Fibrin strands were the most commonly reported issue, with an overall incidence rate of ∼3%. Further, 65% of respondents indicated that these issues contribute to analyzer probe clogging, and the majority of laboratories had visual inspection and manual remediation practices in place to address fibrin- and gel-related quality problems (55% and 70%, respectively). Probe maintenance/replacement, visual inspection and manual remediation were estimated to carry significant costs for the laboratories surveyed. Annual cost associated with lower sample quality and remediation related to fibrin and/or gel globules for an average US laboratory was estimated to be $100,247. Conclusions Measures to improve blood sample quality present an important step towards improved laboratory operations.
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Affiliation(s)
- Erik P Erdal
- 1 Becton Dickinson and Company, Franklin Lakes, NJ, USA
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Cornes MP, Church S, van Dongen-Lases E, Grankvist K, Guimarães JT, Ibarz M, Kovalevskaya S, Kristensen GB, Lippi G, Nybo M, Sprongl L, Sumarac Z, Simundic AM. The role of European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase in standardization and harmonization of the preanalytical phase in Europe. Ann Clin Biochem 2016; 53:539-47. [PMID: 27141012 DOI: 10.1177/0004563216643969] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/16/2022]
Abstract
Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase (EFLM WG-PRE) was established to lead in standardization and harmonization of preanalytical policies and practices at a European level. One of the key activities of the WG-PRE is the organization of the biennial EFLM-BD conference on the preanalytical phase to provide a forum for National Societies (NS) to discuss their issues. Since 2012, a year after the first Preanalytical phase conference, there has been a rapid growth in the number of NS with a working group engaged in preanalytical phase activities and there are now at least 19 countries that have one. As a result of discussions with NS at the third conference held in March 2015 five key areas were identified as requiring harmonisation. These were test ordering, sample transport and storage, patient preparation, sampling procedures and management of unsuitable specimens. The article below summarises the work that has and will be done in these areas. The goal of this initiative is to ensure the EFLM WG-PRE produces work that meets the needs of the European laboratory medicine community. Progress made in the identified areas will be updated at the next preanalytical phase conference and show that we have produced guidance that has enhanced standardisation in the preanalytical phase and improved patient safety throughout Europe.
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Affiliation(s)
- Michael P Cornes
- Departments of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK
| | | | | | - Kjell Grankvist
- The Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden
| | - João T Guimarães
- Department of Clinical Pathology, São João Hospital Center, Department of Biochemistry, Faculty of Medicine, and EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Mercedes Ibarz
- Laboratori Clínic Hospital Arnau de Vilanova, Lleida, Spain
| | - Svetlana Kovalevskaya
- Clinical Laboratory Diagnostic Department with Course of Molecular Medicine, First Saint Petersburg Pavlov State Medical University, St-Petersburg, Russia
| | | | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Ludek Sprongl
- Central Laboratory, Hospital Sumperk, Sumperk, Czech Republic
| | - Zorica Sumarac
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital Sveti Duh, Zagreb, Croatia
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Barker SJ, Shander A, Ramsay MA. Continuous Noninvasive Hemoglobin Monitoring: A Measured Response to a Critical Review. Anesth Analg 2016; 122:565-72. [PMID: 25746056 PMCID: PMC4708068 DOI: 10.1213/ane.0000000000000605] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Supplemental Digital Content is available in the text. Published ahead of print March 5, 2015
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Affiliation(s)
- Steven J. Barker
- From the Department of Anesthesiology, University of Arizona College of Medicine, Tucson, Arizona; Department of Anesthesiology, Englewood Medical Center, Englewood, New Jersey; Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York; and Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, Texas
| | - Aryeh Shander
- From the Department of Anesthesiology, University of Arizona College of Medicine, Tucson, Arizona; Department of Anesthesiology, Englewood Medical Center, Englewood, New Jersey; Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York; and Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, Texas
| | - Michael A. Ramsay
- From the Department of Anesthesiology, University of Arizona College of Medicine, Tucson, Arizona; Department of Anesthesiology, Englewood Medical Center, Englewood, New Jersey; Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York; and Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, Texas
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Piva E, Tosato F, Plebani M. Pre-analytical phase: The automated ProTube device supports quality assurance in the phlebotomy process. Clin Chim Acta 2015; 451:287-91. [DOI: 10.1016/j.cca.2015.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 02/06/2023]
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Nilsson K, Juthberg C, Söderberg J, Bölenius K, Grankvist K, Brulin C, Lindkvist M. Associations between workplace affiliation and phlebotomy practices regarding patient identification and test request handling practices in primary healthcare centres: a multilevel model approach. BMC Health Serv Res 2015; 15:503. [PMID: 26552430 PMCID: PMC4640357 DOI: 10.1186/s12913-015-1157-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/30/2015] [Indexed: 12/16/2022] Open
Abstract
Background Clinical practice guidelines aim to enhance patient safety by reducing inappropriate variations in practice. Despite considerable efforts to enhance the use of clinical practice guidelines, adherence is often suboptimal. We investigated to what extent workplace affiliation explains variation of self-reported adherence to venous blood specimen collection regarding patient identification and test request handling practices, taking into consideration other primary healthcare centre and individual phlebotomist characteristics. Methods Data were collected through a questionnaire survey of 164 phlebotomy staff from 25 primary healthcare centres in northern Sweden. To prevent the impact of a large-scale education intervention in 2008, only baseline data, collected over a 3-month period in 2006–2007, were used and subjected to descriptive statistics and multilevel logistic analyses. Results In two patient identification outcomes, stable high median odds ratios (MOR) were found in both the empty model, and in the adjusted full model including both individual and workplace factors. Our findings suggest that variances among phlebotomy staff can be largely explained by primary healthcare centre affiliation also when individual and workplace demographic characteristics were taken in consideration. Analyses showed phlebotomy staff at medium and large primary healthcare centres to be more likely to adhere to guidelines than staff at small centres. Furthermore, staff employed shorter time at worksite to be more likely to adhere than staff employed longer. Finally, staff performing phlebotomy every week or less were more likely to adhere than staff performing phlebotomy on a daily basis. Conclusion Workplace affiliation largely explains variances in self-reported adherence to venous blood specimen collection guidelines for patient identification and test request handling practices among phlebotomy staff. Characteristics of the workplace, as well as of the individual phlebotomist, need to be identified in order to design strategies to improve clinical practice in this and other areas.
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Affiliation(s)
- Karin Nilsson
- Department of Nursing, Umeå University, Umeå, Sweden.
| | | | - Johan Söderberg
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden.
| | | | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden.
| | | | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden. .,Department of Statistics, Umeå University, Umeå, Sweden.
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Litchfield I, Bentham L, Lilford R, McManus RJ, Hill A, Greenfield S. Test result communication in primary care: a survey of current practice. BMJ Qual Saf 2015; 24:691-9. [PMID: 26243888 PMCID: PMC4680128 DOI: 10.1136/bmjqs-2014-003712] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 06/18/2015] [Indexed: 11/21/2022]
Abstract
Background The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. Methods We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Results Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. Conclusions The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the handling of samples and the reporting of results. Our findings will inform our continuing work with patients and staff to develop, implement and evaluate improvements to existing systems of managing the testing and result communication process.
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Affiliation(s)
- Ian Litchfield
- School of Health and Population Sciences, Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Louise Bentham
- School of Health and Population Sciences, Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard Lilford
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ann Hill
- Department of Transformation, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Sheila Greenfield
- School of Health and Population Sciences, Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Cornes MP, Atherton J, Pourmahram G, Borthwick H, Kyle B, West J, Costelloe SJ. Monitoring and reporting of preanalytical errors in laboratory medicine: the UK situation. Ann Clin Biochem 2015. [DOI: 10.1177/0004563215599561] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Most errors in the clinical laboratory occur in the preanalytical phase. This study aimed to comprehensively describe the prevalence and nature of preanalytical quality monitoring practices in UK clinical laboratories. Methods A survey was sent on behalf of the Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group (ACB-WG-PA) to all heads of department of clinical laboratories in the UK. The survey captured data on the analytical platform and Laboratory Information Management System in use; which preanalytical errors were recorded and how they were classified and gauged interest in an external quality assurance scheme for preanalytical errors. Results Of the 157 laboratories asked to participate, responses were received from 104 (66.2%). Laboratory error rates were recorded per number of specimens, rather than per number of requests in 51% of respondents. Aside from serum indices for haemolysis, icterus and lipaemia, which were measured in 80% of laboratories, the most common errors recorded were booking-in errors (70.1%) and sample mislabelling (56.9%) in laboratories who record preanalytical errors. Of the laboratories surveyed, 95.9% expressed an interest in guidance on recording preanalytical error and 91.8% expressed interest in an external quality assurance scheme. Conclusions This survey observes a wide variation in the definition, repertoire and collection methods for preanalytical errors in the UK. Data indicate there is a lot of interest in improving preanalytical data collection. The ACB-WG-PA aims to produce guidance and support for laboratories to standardize preanalytical data collection and to help establish and validate an external quality assurance scheme for interlaboratory comparison.
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Affiliation(s)
- Michael P Cornes
- Department of Clinical Chemistry, Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group, UK
| | - Jennifer Atherton
- Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group, UK
- Blood Sciences Department, Liverpool Clinical Laboratories, Aintree University Hospital, Liverpool, UK
| | - Ghazaleh Pourmahram
- Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group, UK
- BD Diagnostics, Preanalytical Systems, Oxford, UK
| | - Hazel Borthwick
- Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group, UK
- Clinical Chemistry, Darlington Memorial Hospital, Darlington, UK
| | - Betty Kyle
- Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group, UK
- Clinical Chemistry, Monklands Hospital, Airdrie, UK
| | - Jamie West
- Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group, UK
- Peterborough and Stamford NHS Trust, UK
| | - Seán J Costelloe
- Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group, UK
- Derriford Combined Laboratory, Plymouth Hospitals NHS Trust, Plymouth, UK
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Salinas M, López-Garrigós M, Flores E, Santo-Quiles A, Gutierrez M, Lugo J, Lillo R, Leiva-Salinas C. Ten years of preanalytical monitoring and control: Synthetic Balanced Score Card Indicator. Biochem Med (Zagreb) 2015; 25:49-56. [PMID: 25672466 PMCID: PMC4401317 DOI: 10.11613/bm.2015.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/29/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction Preanalytical control and monitoring continue to be an important issue for clinical laboratory professionals. The aim of the study was to evaluate a monitoring system of preanalytical errors regarding not suitable samples for analysis, based on different indicators; to compare such indicators in different phlebotomy centres; and finally to evaluate a single synthetic preanalytical indicator that may be included in the balanced scorecard management system (BSC). Materials and methods We collected individual and global preanalytical errors in haematology, coagulation, chemistry, and urine samples analysis. We also analyzed a synthetic indicator that represents the sum of all types of preanalytical errors, expressed in a sigma level. We studied the evolution of those indicators over time and compared indicator results by way of the comparison of proportions and Chi-square. Results There was a decrease in the number of errors along the years (P < 0.001). This pattern was confirmed in primary care patients, inpatients and outpatients. In blood samples, fewer errors occurred in outpatients, followed by inpatients. Conclusion We present a practical and effective methodology to monitor unsuitable sample preanalytical errors. The synthetic indicator results summarize overall preanalytical sample errors, and can be used as part of BSC management system.
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Affiliation(s)
- Maria Salinas
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain ; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain
| | - Maite López-Garrigós
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain ; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain
| | - Emilio Flores
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain ; Department of Clinic Medicine, Universidad Miguel Hernandez, Elche, Spain
| | - Ana Santo-Quiles
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | - Mercedes Gutierrez
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | - Javier Lugo
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | - Rosa Lillo
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
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Central Laboratory Service and Point-of-Care Testing in Germany—From Conflicting Notions to Complementary Understandings. POINT OF CARE 2015. [DOI: 10.1097/poc.0000000000000043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Personnel's Experiences of Phlebotomy Practices after Participating in an Educational Intervention Programme. Nurs Res Pract 2014; 2014:538704. [PMID: 25530877 PMCID: PMC4230197 DOI: 10.1155/2014/538704] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/08/2014] [Accepted: 10/11/2014] [Indexed: 12/22/2022] Open
Abstract
Background. Blood specimen collection is a common procedure in health care, and the results from specimen analysis have essential influence on clinical decisions. Errors in phlebotomy may lead to repeated sampling and delay in diagnosis and may jeopardise patient safety. This study aimed to describe the experiences of, and reflections on, phlebotomy practices of phlebotomy personnel working in primary health care after participating in an educational intervention programme (EIP). Methods. Thirty phlebotomists from ten primary health care centres participated. Their experiences were investigated through face-to-face interviews. Findings were analysed using qualitative content analysis. Results. The participants perceived the EIP as having opened up opportunities to reflect on safety. The EIP had made them aware of risks in relation to identification procedures, distractions from the environment, lack of knowledge, and transfer of information. The EIP also resulted in improvements in clinical practice, such as a standardised way of working and increased accuracy. Some said that the training had reassured them to continue working as usual, while others continued as usual regardless of incorrect procedure. Conclusions. The findings show that EIP can stimulate reflections on phlebotomy practices in larger study groups. Increased knowledge of phlebotomy practices improves the opportunities to revise and maximise the quality and content of future EIPs. Educators and safety managers should reflect on and pay particular attention to the identification procedure, distractions from the environment, and transfer of information, when developing and implementing EIPs. The focus of phlebotomy training should not solely be on improving adherence to practice guidelines.
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Li HY, Huang XN, Yang YC, Huang WF, Chen L, Song P, Zhang WY. Reduction of preanalytical errors in clinical laboratory through multiple aspects and whole course intervention measures. J Evid Based Med 2014; 7:172-7. [PMID: 25154748 DOI: 10.1111/jebm.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/30/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Errors in preanalytical phase decrease the accuracy of reports from clinical laboratory department. Considering the disqualified rate of preanalytical sample in our hospital, we performed several intervention measures to improve the situation. METHODS The disqualified sample types and major causes of errors in the preanalytical phase were investigated in clinical laboratory department from September 2008 to August 2009. In the following year, we utilized multiple measures to properly intervene the key points of whole sample collection process, and the preanalytical errors were reanalyzed trimonthly, then the disqualification rate of total, major disqualified sample types and different test groups were calculated to evaluate the effects of the intervention measures. RESULTS The total disqualification rate in the preanalytical phase obtained from September 2008 to August 2009 was 1.36%, and the major types of disqualified samples were coagulation of anticoagulant sample, sample inadequacy, sample container error, sample information error and sample type error. After one year intervention through key points of whole preanalytical sample collection process, the total disqualification rate dropped to 0.94%, and the disqualification rate of coagulation of anticoagulant sample, sample inadequacy, sample container error, sample information error, and sample type error decreased by 20.45%, 28.00%, 25.00%, 76.92%, and 66.66%, respectively. As for test groups, the decreasing amplitude of biochemical, routine, immunological, microbiological and emergency test group was 47.36%, 33.33%, 20.00%, 50.00%, and 21.43%, respectively. CONCLUSIONS The overall effect of the interventions is very good, and the disqualification rate of the main causes decreases to various degrees.
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Affiliation(s)
- Hong-ying Li
- Medical Records Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China
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Abdollahi A, Saffar H, Saffar H. Types and Frequency of Errors during Different Phases of Testing At a Clinical Medical Laboratory of a Teaching Hospital in Tehran, Iran. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:224-8. [PMID: 24926448 PMCID: PMC4049056 DOI: 10.4103/1947-2714.132941] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND According to official data, 60-70% of clinical decisions about hospitalization and discharge are based on laboratory results. AIMS The objective of this study is to examine the frequency of errors before, during, and after analysis in a major medical laboratory. MATERIALS AND METHODS This descriptive, cross-sectional study was conducted throughout 2012 (January-December 2012). Errors are recorded by the Quality Control Committee in a specially designed record. RESULTS A total of 303,866 samples, 2,430,928 tests were received for analysis. The total number of errors was 153,148 (6.3%) (116,392 for inpatients and 36,756 for outpatients). Analysis of the results revealed that about 65.09% of the errors occur across preanalytical phase, whereas 23.2% and 11.68% are related to analytical and postanalytical phase, respectively. CONCLUSION More than half of the laboratory errors are related to preanalytical phase; therefore, proper training and knowledge of intervening factors are essential for reducing errors and optimizing the quality.
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Affiliation(s)
- Alireza Abdollahi
- Department of Clinical Pathology, Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Department of Clinical Pathology, Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hana Saffar
- Department of Clinical Pathology, Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Mohammadzadeh N, Safdari R. The Intelligent Clinical Laboratory as a Tool to Increase Cancer Care Management Productivity. Asian Pac J Cancer Prev 2014; 15:2935-7. [DOI: 10.7314/apjcp.2014.15.6.2935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kristensen GB, Aakre KM, Kristoffersen AH, Sandberg S. How to conduct External Quality Assessment Schemes for the pre-analytical phase? Biochem Med (Zagreb) 2014; 24:114-22. [PMID: 24627720 PMCID: PMC3936964 DOI: 10.11613/bm.2014.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/03/2014] [Indexed: 12/01/2022] Open
Abstract
In laboratory medicine, several studies have described the most frequent errors in the different phases of the total testing process, and a large proportion of these errors occur in the pre-analytical phase. Schemes for registration of errors and subsequent feedback to the participants have been conducted for decades concerning the analytical phase by External Quality Assessment (EQA) organizations operating in most countries. The aim of the paper is to present an overview of different types of EQA schemes for the pre-analytical phase, and give examples of some existing schemes. So far, very few EQA organizations have focused on the pre-analytical phase, and most EQA organizations do not offer pre-analytical EQA schemes (EQAS). It is more difficult to perform and standardize pre-analytical EQAS and also, accreditation bodies do not ask the laboratories for results from such schemes. However, some ongoing EQA programs for the pre-analytical phase do exist, and some examples are given in this paper. The methods used can be divided into three different types; collecting information about pre-analytical laboratory procedures, circulating real samples to collect information about interferences that might affect the measurement procedure, or register actual laboratory errors and relate these to quality indicators. These three types have different focus and different challenges regarding implementation, and a combination of the three is probably necessary to be able to detect and monitor the wide range of errors occurring in the pre-analytical phase.
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Affiliation(s)
| | - Kristin Moberg Aakre
- The Norwegian EQA Program (NKK), Bergen,
Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen,
Norway
| | - Ann Helen Kristoffersen
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen,
Norway
- Noklus (Norwegian Centre for Quality Improvement of Primary Care Laboratories), University of Bergen, Bergen,
Norway
| | - Sverre Sandberg
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen,
Norway
- Noklus (Norwegian Centre for Quality Improvement of Primary Care Laboratories), University of Bergen, Bergen,
Norway
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Nilsson K, Grankvist K, Juthberg C, Brulin C, Söderberg J. Deviations from venous blood specimen collection guideline adherence among senior nursing students. NURSE EDUCATION TODAY 2014; 34:237-242. [PMID: 23870690 DOI: 10.1016/j.nedt.2013.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 05/02/2013] [Accepted: 06/12/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Despite considerable efforts to increase patient safety by supporting the use of best practice medical and nursing guidelines by healthcare staff, adherence is often suboptimal. Swedish nurses often deviate from venous blood specimen collection (VBSC) guideline adherence. We assessed the adherence to national VBSC guidelines among senior nursing students. METHODS We conducted a cross-sectional, self-reported questionnaire survey among 101 out of 177 senior nursing students consisting of web-based students in their fifth semester and campus-based students in their fifth or sixth semester out of six. In regard to the VBSC procedures, we asked about adherence to the patient identification, test request handling, and test tube labelling protocols that the students had learned during their second semester and practiced thereafter. RESULTS Guideline adherence to patient identification was reported by 81%, test request handling by 74%, and test tube labelling by 2% of the students. Students with no prior healthcare education reported to a higher extent that they operated within the guidelines regarding labelling the test tube before entering the patient's room compared to students with prior healthcare education. Using multiple logistic regression analysis, we found that fifth semester web-based program students adhered better to VBSC guidelines regarding comparing patient ID/test request/tube label compared to campus-based students. CONCLUSIONS Senior nursing students were found to adhere to VBSC guidelines to a similar extent as registered nurses and other hospital ward staff in clinical healthcare. Thus student adherence to VBSC guidelines had deteriorated since their basic training in the second semester, and this can impact patient safety during university/clinical studies. The results of our study have implications for nursing practice education.
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Affiliation(s)
- Karin Nilsson
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | | | | | - Johan Söderberg
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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Impact of proficiency testing program for laboratories conducting early diagnosis of HIV-1 infection in infants in low- to middle-income countries. J Clin Microbiol 2013; 52:773-80. [PMID: 24353004 DOI: 10.1128/jcm.03097-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A voluntary, cost-free external quality assessment (EQA) program established by the U.S. Centers for Disease Control and Prevention (CDC) was implemented to primarily monitor the performance of laboratories conducting HIV Early Infant Diagnosis (EID) from dried blood spots (DBS) in low- to middle-income countries since 2006. Ten blind DBS proficiency test (PT) specimens and 100 known HIV-positive and -negative DBS specimens (to be used as internal controls) were shipped triannually to participating laboratories with reports for the PT specimens due within 30 days. The participant's results and a summary of the performance of all participating laboratories and each diagnostic method were provided after each test cycle. Enrollment in the CDC PT program expanded progressively from 17 laboratories from 11 countries in 2006 to include 136 laboratories from 41 countries at the end of 2012. Despite external pressures to test and treat more children while expanding EID programs, mean PT test scores significantly improved over time as demonstrated by the upward trend from mid-2006 to the end of 2012 (P=0.001) and the increase in the percentage of laboratories scoring 100% (P=0.003). The mean test scores plateaued over the past 10 testing cycles, ranging between 98.2% and 99.7%, and discordant test results still occur but at a rate of no higher than 2.6%. Analysis of these test results suggests a positive impact of proficiency testing on the testing performance of the participating laboratories, and a continuous training program and proficiency testing participation may translate into laboratories improving their testing accuracy.
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Bölenius K, Lindkvist M, Brulin C, Grankvist K, Nilsson K, Söderberg J. Impact of a large-scale educational intervention program on venous blood specimen collection practices. BMC Health Serv Res 2013; 13:463. [PMID: 24192426 PMCID: PMC4228245 DOI: 10.1186/1472-6963-13-463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phlebotomy performed with poor adherence to venous blood specimen collection (VBSC) guidelines jeopardizes patient safety and may lead to patient suffering and adverse events. A first questionnaire study demonstrated low compliance to VBSC guidelines, motivating an educational intervention of all phlebotomists within a county council. The aim was to evaluate the impact of a large-scale educational intervention program (EIP) on primary health care phlebotomists' adherence to VBSC guidelines. We hypothesised that the EIP would improve phlebotomists' VBSC practical performance. METHODS The present study comprise primary health care centres (n = 61) from two county councils in northern Sweden. The final selected study group consisted of phlebotomists divided into an intervention group (n = 84) and a corresponding control group (n = 79). Both groups responded to a validated self-reported VBSC questionnaire twice. The EIP included three parts: guideline studies, an oral presentation, and an examination. Non-parametric statistics were used for comparison within and between the groups. RESULTS Evaluating the EIP, we found significant improvements in the intervention group compared to the control group on self-reported questionnaire responses regarding information search (ES = 0.23-0.33, p < 0.001-0.003), and patient rest prior to phlebotomy (ES = 0.27, p = 0.004). Test request management, patient identity control, release of venous stasis, and test tube labelling had significantly improved in the intervention group but did not significantly differ from the control group (ES = 0.22- 0.49, p = < 0.001- 0.006). The control group showed no significant improvements at all (ES = 0-0.39, p = 0.016-0.961). CONCLUSIONS The present study demonstrated several significant improvements on phlebotomists' adherence to VBSC practices. Still, guideline adherence improvement to several crucial phlebotomy practices is needed. We cannot conclude that the improvements are solely due to the EIP and suggest future efforts to improve VBSC. The program should provide time for reflections and discussions. Furthermore, a modular structure would allow directed educational intervention based on the specific VBSC guideline flaws existing at a specific unit. Such an approach is probably more effective at improving and sustaining adherence to VBSC guidelines than an EIP containing general pre-analytical practices.
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Affiliation(s)
- Karin Bölenius
- Department of Nursing, Umeå University, Building A, 4th floor, 901 87 Umeå, Sweden.
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Rana SV. No preanalytical errors in laboratory testing: a beneficial aspect for patients. Indian J Clin Biochem 2013; 27:319-21. [PMID: 24082454 DOI: 10.1007/s12291-012-0271-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Satyavati V Rana
- Department of Super Specialty Gastroenterology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
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Karlsson J, Helmersson-Karlqvist J, Larsson A. Delayed mixing of vacuum tubes clearly affects platelet counts but not haemoglobin concentration and prothrombin time (INR) results. Int J Lab Hematol 2013; 35:e15-7. [DOI: 10.1111/ijlh.12096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Karlsson
- Department of Medical Sciences; Section of Clinical Chemistry; Uppsala University; Uppsala Sweden
| | - J. Helmersson-Karlqvist
- Department of Medical Sciences; Section of Clinical Chemistry; Uppsala University; Uppsala Sweden
| | - A. Larsson
- Department of Medical Sciences; Section of Clinical Chemistry; Uppsala University; Uppsala Sweden
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Medical error, disclosure and patient safety: a global view of quality care. Clin Biochem 2013; 46:1161-9. [PMID: 23578740 DOI: 10.1016/j.clinbiochem.2013.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022]
Abstract
Medical errors are a prominent issue in health care. Numerous studies point at the high prevalence of adverse events, many of which are preventable. Although there is a range of severity in errors, they all cause harm, to the patient, to the system, or both. While errors have many causes, including human interactions and system inadequacies, the focus on individuals rather than the system has led to an unsuitable culture for improving patient safety. Important areas of focus are diagnostic procedures and clinical laboratories because their results play a major role in guiding clinical decisions in patient management. Proper disclosure of medical errors and adverse events is also a key area for improvement. Globally, system improvements are beginning to take place, however, in Canada, policies on disclosure, error reporting and protection for physicians remain non-uniform. Achieving a national standard with mandatory reporting, in addition to a non-punitive system is recommended to move forward.
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