Analysis of preanalytical errors in a clinical chemistry laboratory: A 2-year study

Abstract

Patient safety and medical diagnosis of patients are mainly influenced by laboratory results. The present study aimed to evaluate the errors in the preanalytical phase of testing in a Clinical Chemistry diagnostic laboratory. A review was conducted at the Clinical Chemistry Laboratory of a hospital in Saudi Arabia from January 2019 to December 2020. Using the laboratory information system, the data of all canceled tests and requests were retrieved and evaluated for preanalytical errors. A total of 55,345 laboratory test requests and samples from different departments were evaluated for preanalytical errors. An overall rate of 12.1% (6705) was determined as preanalytical errors. The occurrence of these errors was found to be highest in the emergency department (21%). The leading preanalytical errors were nonreceived samples (3.7%) and hemolysis (3.5%). The annual preanalytical errors revealed an increasing rate in outpatient and inpatient departments, while a decreasing rate was observed in the emergency department. An increased rate of errors was also noted for the 2-year study period from 11.3% to 12.9%. The preanalytical phase has a significant impact on the quality of laboratory results. The rate of error in the study was high and the leading causes were nonreceived samples and hemolysis. An increased occurrence of hemolyzed samples in the outpatient department was noted. Enhanced educational efforts emphasizing specimen quality issues and training in sample collection among hospital staff must be carried out.

Determining the rate and reasons for specimen rejection among specimens referred for HIV viral load determination through referral linkage to Debre Tabor Comprehensive Specialized Hospital, north-central, Ethiopia,2023: Retrospective study

“…This finding is nearly similar to a study conducted at the Cantonal Hospital Zenica in Bosnia and Herzegovina, which found that 11.63 % [ 19 ] of samples were rejected due to insufficient quantity. However, this result is higher than the findings of a study conducted at the University of Gondar Hospital in Northwest Ethiopia, 0.1 % [ 15 ]; Saudi Arabia, 1.7 % [ 14 ]; India, 0.2 % [ 28 ]; and India, 1.6 % [ 27 ]. On the other side, our study's findings are lower than the result of the study done in Oromia, Ethiopia, 23.3 % [ 25 ], and Libya, 50 % [ 23 ] of samples were rejected due to insufficient quantity.…”

“…However, the overall sample rejection at the pre-analytical phase in the current study is higher than the studies conducted at Amhara Public Health Institute in Bahir Dar, Ethiopia, 0.5 % [ 9 ]; St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, 1.4 % [ 1 ]; Delhi, 1.52 % [ 18 ]; Cantonal Hospital Zenica, 1.7 % [ 19 ]; and Makkah, Saudi Arabia, 1.3 % [ 20 ]. On the other hand, our study's finding indicates a lower rate of overall sample rejection in the pre-analytical phase compared to the rate of overall pre-analytical sample rejection of previous studies conducted at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia,26 % [ 2 ]; St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia,72.3 % [ 21 ], and Saudi Arabia, 12.1 % [ 14 ]. This difference could be attributed to the sample size difference, workload, and not adhering to standard specimen collection procedures.…”

“…Improving the overall quality of laboratory medicine requires recognizing, documenting, and monitoring errors in the laboratory that can compromise the accuracy of test results and patient diagnosis and care [ 14 ].…”

“…This finding is lower than the findings of research conducted in Oromia, Ethiopia, 21.9 % [ 25 ]; Saudi Arabia, 20.09 % [ 20 ]; Cantonal Hospital Zenica in Bosnia and Herzegovina, 39.87 % [ 19 ]; and Libya, 25 % [ 23 ] of specimens were rejected due to the occurrence of the clot. A study conducted in Saudi Arabia [ 14 ], however, found a lower proportion, i.e., 0.08 % specimen rejection rate due to the clotting of specimens. The general rule is that when the proportion of blood specimens to anticoagulants is high, the specimen will clot.…”

Frequency and types of pre-analytical errors in a clinical laboratory of a specialized healthcare hospital

“… 1 It is essential to comprehend and acknowledge the origins of these errors to effectively address unexpected laboratory results which do not align with clinical information. 2 A myriad of causes may exist. Sometimes, even, the specific circumstances at the regional level, such as pandemics, possess the capacity to amplify the rate of pre-analytical errors.…”