An error management system in a veterinary clinical laboratory

Abstract

Abstract. Error recording and management is an integral part of a clinical laboratory quality management system. Analysis and review of recorded errors lead to corrective and preventive actions through modification of existing processes and, ultimately, to quality improvement. Laboratory errors can be divided into preanalytical, analytical, and postanalytical errors depending on where in the laboratory cycle the errors occur. The purpose of the current report is to introduce an error management system in use in a veterinary diagnostic laboratory as well as to examine the amount and types of error recorded during the 8-year period from 2003 to 2010. Annual error reports generated during this period by the error recording system were reviewed, and annual error rates were calculated. In addition, errors were divided into preanalytical, analytical, postanalytical, and "other" categories, and their frequency was examined. Data were further compared to that available from human diagnostic laboratories. Finally, sigma metrics were calculated for the various error categories. Annual error rates per total number of samples ranged from 1.3% in 2003 to 0.7% in 2010. Preanalytical errors ranged from 52% to 77%, analytical from 4% to 14%, postanalytical from 9% to 21%, and other error from 6% to 19% of total errors. Sigma metrics ranged from 4.1 to 4.7. All data were comparable to that reported in human clinical laboratories. The incremental annual reduction of error shows that use of an error management system led to quality improvement.Key words: Error management; laboratory error; quality management; veterinary laboratory. Special ArticleError management in a veterinary laboratory 459 laboratories. A small number of reports have been published about error management in human laboratory medicine.Most of the studies concerning human laboratory error management advocate the use of an error management system that evaluates errors within the framework of the Total Testing Process (TTP). 1,7,15,16 The TTP breaks laboratory testing down into 11 steps, starting with a clinical question that prompts a test selection and ending with the impact of the test result on patient care.2 These steps are grouped into preanalytical, analytical, and postanalytical phases, with some authors also describing pre-preanalytical and postpostanalytical phases. 15 Alternatively, errors may also be classified according to who bears responsibility for the event, preventability, or the impact on patient care.10 Such studies concerning error management in human medical laboratories are heterogeneous, and reported error rates differ according to study design, TTP steps analyzed, and whether results are reported per patient, per sample, or per test result. Results vary from errors occurring in 0.05% of patients in a clinical chemistry section to 0.61% of test results across a whole laboratory over 3 years.3 Other studies report error frequencies as 1:1,000 (0.1%), 1 error per 33-50 events (2-3%), or 1 error per 214-8,300 (0.01-0.5%) of laboratory results. ...

Types and frequency of errors during different phases of testing at a clinical medical laboratory of a teaching hospital in Tehran, Iran

“…According to official data, 60–70% of clinical decisions about hospitalization, discharge, and prescription are based on laboratory results. [1234] Clinical tests enjoy a high status in screening, treatment follow-up, and assessment of response to treatment. [1234] Given this high percentage and the significant role, the quality of laboratory tests is of high importance.…”

“…[1234] Clinical tests enjoy a high status in screening, treatment follow-up, and assessment of response to treatment. [1234] Given this high percentage and the significant role, the quality of laboratory tests is of high importance. [1234] In other words, quality is the cornerstone of management in a laboratory[56] and it needs to conform to the highest standards.…”

“…[1234] Given this high percentage and the significant role, the quality of laboratory tests is of high importance. [1234] In other words, quality is the cornerstone of management in a laboratory[56] and it needs to conform to the highest standards. [56] Laboratory services need to be accurate, precise, and quick to prove effective.…”

The preanalytic phase in veterinary clinical pathology

“…The quantitative importance of preanalytic errors in veterinary clinical pathology has been little investigated. To our knowledge, there is only one quantitative report by an Austrian laboratory where preanalytic errors accounted for about 2/3 of the errors recorded . Except in animal hospitals and experimental settings, sampling is performed by veterinarians or nurses, who are skilled professionals but usually not specialists in clinical pathology.…”

Recognizing and Reducing Analytical Errors and Sources of Variation in Clinical Pathology Data in Safety Assessment Studies

“…Hooijberg, Leidinger, and Freeman (2012) evaluated a commercial veterinary clinical pathology laboratory during an 8-year period and determined that the annual error rate/total number of samples ranged from 0.7 to 1.3%. Error results were categorized as preanalytical (52 to 77%), analytical (4 to 14%), postanalytical (9 to 21%), and others (6 to 19%).…”