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Romero A, Gómez-Salgado J, Romero-Arana A, Ortega-Moreno M, Jódar-Sánchez F, Ruiz-Frutos C. Costs analysis of a training intervention for the reduction of preanalytical errors in primary care samples. Medicine (Baltimore) 2020; 99:e21385. [PMID: 32756129 PMCID: PMC7402912 DOI: 10.1097/md.0000000000021385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To perform a cost-error analysis based on a quasi-experimental pre-post study of the preanalytical errors in 2 hospital laboratories. The real cost and theoretical cost are defined as the cost resulting from errors with or without the training intervention. The real impact associated to the training program was estimated, calculated as the total associated to the preanalytical errors cost difference. The costs were measured using Andalusian Public Health Service fees. Cost analysis of an educational intervention presented in a previous study from 2017. Preanalytical errors were detected in the laboratories of the University Hospital Virgen de la Victoria (Málaga, Spain) and in the University Hospital Juan Ramón Jiménez (Huelva, Spain). METHODS The founded errors were divided into blood and urine samples. Univariate sensitivity analysis was used to assess how parameter uncertainty impacted on overall results. Variations of parameters between 0% and 5% were substituted into the base case. RESULTS The real impact associated with educational intervention in LAB1 was an increase of &OV0556;16,961.378, and the expected impact was an increase &OV0556;78,745.27 (difference of &OV0556;61,783.9). In LAB2, the real impact in the same period amounted to &OV0556;260,195.37, and the expected impact was &OV0556;193,905.83 (difference of -&OV0556;66,289.54). The results were different in the 2 laboratories, proving the intervention in only one of them to be more effective. CONCLUSIONS Costs analysis determined that this training intervention can provide saves in the costs, as the effectiveness of the educational sessions in reducing preanalytical errors currently results in a significant decrease of the costs associated with these errors.
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Affiliation(s)
- Adolfo Romero
- Nursing and Podiatry Department, University Hospital Virgen de la Victoria, Health Sciences School, University of Málaga, IBIMA (Institute of Biomedicine Research, Málaga), Málaga
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Adolfo Romero-Arana
- Andalusian Public Foundation for the Biomedical Research in Malaga (FIMABIS), Málaga
| | | | - Francisco Jódar-Sánchez
- Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine Research of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Romero-Arana A, Prieto-Callejero B, Fagundo-Rivera J, Gómez-Salgado J, Romero-Martín M, Ruiz-Frutos C, Romero A. Transcultural Adaptation and Piloting of the "Regarding Blood-Sampling Practices at Primary Health Care Centres" Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3541. [PMID: 32438576 PMCID: PMC7277440 DOI: 10.3390/ijerph17103541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Abstract
Preanalytical errors account for up to 70% of the total potentially detectable errors in the laboratory. The main problems detected are related with procedures associated with Primary Care nursing practices that are directly involved in the preanalytical phase. The objective of this study is to carry out a transcultural adaptation and piloting of the "Regarding Blood-Sampling Practices at Primary Health Care Centres" questionnaire as regards blood sampling in Primary Care. For this, a cross-sectional descriptive study has been developed within the Primary Care area of the Andalusian Public Health System. The venous blood sampling questionnaire was translated into and adapted to Spanish by qualified professionals and expert translators. The questionnaires were then delivered to all staff nurses from the health districts involved. The total sample consisted of 224 primary care nursing professionals. The factors that showed statistically significant relationships were identification and sample collection, management with information search, storage and labelling of samples, and reporting of errors. A lack of global relationship between factors makes it impossible to find a global quality factor in the sampling process. The process of translation, adaptation, and piloting of the questionnaire from its original version to the Spanish one has proven to be understandable by professionals in its entirety and to offer data similar to the original version.
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Affiliation(s)
- Adolfo Romero-Arana
- Andalusian Public Foundation for the Biomedical Research in Malaga (FIMABIS), Nursing Intensive Care Unit, Hospital Regional Universitario, 29010 Málaga, Spain;
| | | | - Javier Fagundo-Rivera
- Andalusian Health Service, Health Sciences Doctorate School, University of Huelva, 21007 Huelva, Spain;
| | - Juan Gómez-Salgado
- Faculty of Social Work, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 091650, Ecuador
| | | | - Carlos Ruiz-Frutos
- Faculty of Social Work, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 091650, Ecuador
| | - Adolfo Romero
- Instituto de Investigación Biomédica de Málaga (IBIMA), Nursing and Podiatry Department, Health Sciences School, University of Málaga, 29010 Málaga, Spain;
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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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Romero A, Gómez-Salgado J, Romero-Arana A, Ruiz-Frutos C. Utilization of a healthcare failure mode and effects analysis to identify error sources in the preanalytical phase in two tertiary hospital laboratories. Biochem Med (Zagreb) 2019; 28:020713. [PMID: 30022888 PMCID: PMC6039167 DOI: 10.11613/bm.2018.020713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/25/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction The presence of errors in the preanalytical phase is a thoroughly studied problem. A strategy to increase their source detection might be the use of the Healthcare Failure Mode and Effects Analysis (HFMEA). The aim of this study is improving the capacity of identifying sources of error during the preanalytical period in samples provided by primary care clinics (PCC) with the use of the HFMEA as a tool in the laboratories of two tertiary hospitals. Materials and methods A HFMEA was carried out in each laboratory, by means of the creation of groups of experts with similar characteristics (doctors and nurses from PCC and laboratory, support staff, and laboratory technicians). The Risk Priority Number (RPN) was calculated. Results Items with elevated RPN were presented in both centers. The highest RPN were in LAB1: "two request notes for a patient" and "the segregation of oncology urgent samples" (both with 384), while in LAB2 was "the lack of information in patients with oral glucose overload test" (RPN 576). Considering the different steps in the preanalytical phase, LAB1 paid attention in sampling, samples reception and the programming in the Laboratory Information System, while LAB2 paid attention in the request form, the appointment system, sampling procedures, transport and reception. Conclusion The laboratories prioritized the problems differently. However, both centers offer solutions to these possible sources of error. We proposed improvement actions that can be resolved easily, with a low cost for the system, mainly to schedule a specific formative programme and a deep revision of the existing protocols.
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Affiliation(s)
- Adolfo Romero
- Haematology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Nursing Department, Health Sciences School, University of Málaga, Spain
| | - Juan Gómez-Salgado
- School of Nursing, University of Huelva, Huelva, Spain.,University Espiritu Santo, Guayaquil, Ecuador
| | | | - Carlos Ruiz-Frutos
- University Espiritu Santo, Guayaquil, Ecuador.,Environmental Sciences Department, University of Huelva, Huelva, Spain
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Li L, Vecellio E, Gay S, Lake R, Mackay M, Burnett L, Chesher D, Braye S, Badrick T, Westbrook JI, Georgiou A. Making sense of a haemolysis monitoring and reporting system: a nationwide longitudinal multimethod study of 68 Australian laboratory participant organisations. ACTA ACUST UNITED AC 2017; 56:565-573. [DOI: 10.1515/cclm-2017-0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
The key incident monitoring and management systems (KIMMS) quality assurance program monitors incidents in the pre- and postanalytical phases of testing in medical laboratories. Haemolysed specimens have been found to be the most frequent preanalytical error and have major implications for patient care. The aims of this study were to assess the suitability of KIMMS for quality reporting of haemolysis and to devise a meaningful method for reporting and monitoring haemolysis.
Methods:
A structured survey of 68 Australian KIMMS laboratory participant organisations was undertaken. Quarterly haemolysis reports (2011–2014) were analysed.
Results:
Among 110 million accessions reported, haemolysis rates varied according to the reporting methods that participants used for assigning accessions (16% of participants reported haemolysis by specimen and 83% reported by episode) and counting haemolysis rejections (61% by specimen, 35% by episode and 3% by test). More than half of the participants (56%) assigned accessions by episode and counted rejections by specimen. For this group, the average haemolysis rate per 100,000 episodes was 177 rejected specimens with the average rate varying from 100 to 233 over time. The majority of participants (91%) determined rejections using the haemolysis index. Two thirds of participants (66%) recorded the haemolysis manually in laboratory information systems.
Conclusions:
KIMMS maintains the largest longitudinal haemolysis database in the world. However, as a means of advancing improvements in the quality of the preanalytical laboratory process, there is a need to standardise reporting methods to enable robust comparison of haemolysis rejection rates across participant laboratories.
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Affiliation(s)
- Ling Li
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Elia Vecellio
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
- South Eastern Area Laboratory Services, NSW Health Pathology , Sydney, NSW , Australia
| | - Stephanie Gay
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Rebecca Lake
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Mark Mackay
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Leslie Burnett
- Genome.One, Garvan Institute of Medical Research , Darlinghurst, NSW , Australia
- Northern Clinical School, Sydney Medical School , University of Sydney , NSW , Australia
| | - Douglas Chesher
- Northern Clinical School, Sydney Medical School , University of Sydney , NSW , Australia
- Pathology North, NSW Health Pathology, Royal North Shore Hospital , St. Leonards, NSW , Australia
| | - Stephen Braye
- Pathology North, NSW Health Pathology, Royal North Shore Hospital , St. Leonards, NSW , Australia
- Pathology North, NSW Health Pathology , Newcastle, NSW , Australia
| | - Tony Badrick
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
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Bodansky DMS, Lumley SE, Chakraborty R, Mani D, Hodson J, Hallissey MT, Tucker ON. Potential cost savings by minimisation of blood sample delays on care decision making in urgent care services. Ann Med Surg (Lond) 2017; 20:37-40. [PMID: 28702185 PMCID: PMC5491485 DOI: 10.1016/j.amsu.2017.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/06/2017] [Accepted: 06/11/2017] [Indexed: 11/28/2022] Open
Abstract
Background Timely availability of blood sample results for interpretation affects planning and delivery of patient care from initial assessment in Accident and Emergency (A&E) departments. Materials and methods Rates of, and reasons for, rejected blood samples submitted from all clinical areas over one month were evaluated. Haemoglobin (Hb) represented haematology and potassium (K+), biochemistry. A prospective observational study evaluated the methodology of sample collection and impact on utility. Results 16,061 haematology and 16,209 biochemistry samples were evaluated; 1.4% (n = 229, range 0.5–7.3%) and 4.7% (n = 762, range 0.9–14%) respectively were rejected, with 14% (n = 248/1808) K+ rejection rate in A&E. Patients with rejected K+ and Hb had a longer median in-hospital stay of 9 and 76 h respectively and additional stay fixed costs of £26,824.74 excluding treatment. The rejection rate with Vacutainer and butterfly (4.0%) was lower than Vacutainer and cannula (28%). Conclusion Sample rejection rate is high and is associated with increased in-hospital stay and cost. Blood sampling technique impacts on rejection rates. Reduction in sample rejection rates in emergency care areas in acute hospitals has the potential to impact on patient flow and reduce cost. Conclusion Blood sample rejection rate in a single large NHS Foundation Trust is high. The highest rate of blood sample rejection is in the Accident and Emergency department. Blood sample rejection is associated with increased in-hospital stay. Blood sampling technique impacts on rejection rates. Reduction in sample rejection rates in emergency care areas in acute hospitals has the potential to impact on patient flow and cost.
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Affiliation(s)
| | - Sophie E Lumley
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | | | - Dhanasekaran Mani
- Health Informatics Unit, University Hospitals Birmingham, Birmingham, UK
| | - James Hodson
- Health Informatics Unit, University Hospitals Birmingham, Birmingham, UK
| | - Mike T Hallissey
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Olga N Tucker
- Department of Surgery, University of Birmingham, Birmingham, UK.,Heart of England NHS Foundation Trust and University of Birmingham, Birmingham, UK
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7
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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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Ying Li H, Yang YC, Huang WF, Li YF, Song P, Chen L, Lan Y. Reduction of preanalytical errors in laboratory by establishment and application of training system. J Evid Based Med 2014; 7:258-62. [PMID: 25586456 DOI: 10.1111/jebm.12125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Errors in preanalytical phase occupied for almost half of total errors in clinical laboratory, and the causes are related to medical staff's quality awareness and behaviors. In order to reduce the preanalytical errors in our hospital, we established and applied a training system 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 established and applied a training system to affect the quality awareness and behaviors of medical staff. Questionnaire investigation was analyzed to illustrate the changes of respondents' quality awareness and behavior, and the preanalytical errors were reanalyzed according to different departments 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 application of established training system, respondents' quality awareness on preanalytical samples changed dominantly, and respondents' own behavior and behavior to others also changed notably. The total disqualification rate in preanalytical phase dropped to 0.94%, among 33 clinical departments, the preanalytical errors in 25 departments decreased to various degrees, and 10 departments had overall decreasing amplitude over 50%. CONCLUSIONS The overall effect of the application of established training system is very good, and the disqualification rate of the major departments decrease 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, Chengdu, China
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9
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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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Gómez-Salgado J, Romero A, Cobos A, Caparrós IS, Gómez-Fernández JA, Domínguez JA, Ruiz-Frutos C. Preanalytical errors: the professionals’ perspective. Clin Chem Lab Med 2014; 52:e53-5. [DOI: 10.1515/cclm-2013-0930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/05/2013] [Indexed: 11/15/2022]
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Romero A, Cobos A, Gómez J, Muñoz M. Role of training activities for the reduction of pre-analytical errors in laboratory samples from primary care. Clin Chim Acta 2011; 413:166-9. [PMID: 21964461 DOI: 10.1016/j.cca.2011.09.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/25/2011] [Accepted: 09/10/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The presence of pre-analytical errors (PE) is a usual contingency in laboratories. The incidence may increase where it is difficult to control that period, as it is the case with samples sent from primary care (PC) to clinical reference laboratory. Detection of a large number of PE in PC samples in our Institution led to the development and implementation of preventive strategies. The first of these has been the realization of a cycle of educational sessions for PC nurses, followed by the evaluation of their impact on PE number. METHODS The incidence of PE was assessed in two periods, before (October-November 2007) and after (October-November, 2009) the implementation of educational sessions. Eleven PC centers in the urban area and 17 in the rural area participated. In the urban area, samples were withdrawn by any PC nurse; in the rural area, samples were obtained by the patient's reference nurse. The types of analyzed PE included missed sample (MS), hemolyzed sample (HS), coagulated sample (CS), incorrect sample (ISV) and others (OPE), such as lipemic or icteric serum or plasma. RESULTS In the former period, we received 52,669 blood samples and 18,852 urine samples, detecting 3885 (7.5%) and 1567 (8.3%) PEs, respectively. After the educational intervention, there were 52,659 and 19,048 samples with 5057 (9.6%) and 1.256 (6.5%) PEs, respectively (p<0.001). According to the type of PE, the incidents compared before and after compared incidences were: MS, 4.8% vs. 3.8%, p<0.001; HS, 1.97% vs. 3.9%, p<0.001; CS, 0.54% vs. 0.25%, p<0.001; ISV, 0.15% vs. 0.19% p=0.08; and OPE, 0.3% vs. 0.42%, p<0.001. CONCLUSIONS Surprisingly the PE incidence increased after the educational intervention, although it should be noted that it was primarily due to the increase of HS, as the other EP incidence decreased (MS and CS) or remained unchanged (ISV). This seems to indicate the need for a comprehensive approach to reduce the incidence of errors in the pre-analytical period, as one stage interventions do not seem to be effective enough.
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Affiliation(s)
- Adolfo Romero
- Unidad de Gestión Clínica de Hematología y Laboratorio, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
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