Error rates during blood collection in emergency departments and outpatient clinics: Results of a prospective multicenter study

Lippi, Giuseppe; Caola, Iole; Cervellin, Gianfranco; Milanesi, Bruno; Morandini, Margherita; Giavarina, Davide

doi:10.1016/j.cca.2015.03.022

Cited by 10 publications

(6 citation statements)

References 7 publications

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“…Published literature has demonstrated interference by icterus predominantly occurs through spectral properties or chemical reaction with enzymatic methods [ 13 , 14 ]. In contrast to hemolysis, high levels of bilirubin are related to patient disease conditions as opposed to pre-analytical factors such as phlebotomy technique, specimen transport, and specimen processing [ 18 , 31 ]. In this sense, icterus has more similarity to lipemia, for which disease conditions such as diabetes and dyslipidemias underlie many cases leading to severe lipemia [ 3 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Frequency of icteric interference in clinical chemistry laboratory tests and causes of severe icterus

Mainali

Merrill

Krasowski

2021

Practical Laboratory Medicine

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Objectives The aims of this study were to identify the causes of severe icterus in an academic medical center patient population and to assess the impact of icterus on clinical chemistry testing using assay package insert thresholds. Design and Methods : In this retrospective study at an academic medical center core clinical laboratory, icteric, hemolysis, and lipemia indices were available for all serum and plasma chemistry specimens analyzed on Roche Diagnostics cobas 8000 analyzers over a 12-month period, encompassing 414,502 specimens from 94,081 unique patients (51,851 females; 42,230 males) including children, inpatient, outpatient, and emergency department patients. Extensive chart review was done for all 57 patients (4 pediatric, 53 adult; 534 total specimens) who had one or more samples with an icteric index of 40 or higher (defined as severe icterus). Results Specimen icteric index exceeded package insert icteric index thresholds in 0.14% of clinical chemistry assays, with the highest number of instances for creatinine (1358 samples, 0.6% of total tests), total protein (1194 samples, 2.2%), and ammonia (161 samples, 3.9%). The 57 patients with an icteric index of 40 or higher accounted for 49.7% of all instances where the icteric index exceeded the specific assay package insert limit. The most common etiologies of this group of 57 patients were alcohol-related liver disease (34 patients), biliary tract disease (7 patients), and neoplasms (6 patients). Conclusions Approximately half of all instances where specimen icteric index exceeded assay package insert thresholds occurred in a small cohort of patients with severe liver/biliary tract disease.

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Section: Discussionmentioning

confidence: 99%

Frequency of icteric interference in clinical chemistry laboratory tests and causes of severe icterus

Mainali

Merrill

Krasowski

2021

Practical Laboratory Medicine

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“…Previously, Lippi et al (4) designed a multicenter prospective study which was planned to compare the frequency of five most frequent preanalytical problems occurring during venous blood collection as recorded in outpatient clinics and emergency departments. According to the results of this multicenter prospective study, blood samples collected at emergency department hospitals were 10 times as faulty as those taken at outpatient clinics managed by laboratory professionals.…”

Section: Discussionmentioning

confidence: 99%

“…They reported that education and training programs of phlebotomists who are out of laboratory control should be fortified so that sample quality and patient safety can be enhanced (4). The objective of our study was to share an experience of an education program on preanalytic phase performed on Emergency Department (ED) staff.…”

Section: Introductionmentioning

confidence: 99%

Pre-Test and Post-Test Applications to Shape the Education of Phlebotomists in A Quality Management Program: An Experience in A Training Hospital

Aykal¹,

Keşaplı²,

Aydın³

et al. 2016

Journal of Medical Biochemistry

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SummaryBackgroundAfter the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED).MethodsAn education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED. A questionary which included 11 questions about the preanalytic phase was applied to all the attendees before and after training. The number of rejected samples per million was discovered with right proportion account over the number of accepted and rejected samples to laboratory after and before the training period.ResultsMost of the attendees were nurses (n: 22/55%), with over 12 years of experience in general and 2–4 years experience in the ED. Knowledge level of the attendees was calculated before training as 58.9% and after training as 91.8%. While the total rate of sample rejection before training was 2.35% (sigma value 3.37–3.50), the rate after training was 1.56% (sigma value 3.62–3.75).ConclusionsIncreasing the knowledge of staff has a direct positive impact on the preanalytic phase. The application of a pre-test was observed to be a feasible tool to shape group specific education programs.

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“…This paper describes the adaptive TLS sampling design used for the COMPASS study. The primary study outcome was based on objective blood samples that were collected by trained clinical professionals and phlebotomists, reducing measurement and processing errors in the assays 16 . To guard against nonresponse due to evolving stay-at-home guidelines, the study developed a novel adaptive sampling frame that adjusted to current closure policies and updated the selection probabilities based on enrollment information from previous weeks.…”

Section: Introductionmentioning

confidence: 99%

Adaptive Time Location Sampling for Compass, a Sars-Cov-2 Prevalence Study in Fifteen Diverse Communities in the United States

Zangeneh

Skalland

Yuhas

et al. 2023

Preprint

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The COVPN 5002 (COMPASS) study aimed to estimate the prevalence of SARS-CoV-2 (active SARS-CoV-2 or prior SARS-CoV-2 infection) in children and adults attending public venues in 15 socio-demographically diverse communities in the United States. To protect against potential challenges in implementing traditional sampling strategies, time-location sampling (TLS) using complex sampling involving stratification, clustering of units, and unequal probabilities of selection was used to recruit individuals from neighborhoods in selected communities. The innovative design adapted to constraints such as closure of venues; changing infection hotspots; and uncertain policies. Recruitment of children and the elderly raised additional challenges in sample selection and implementation. To address these challenges, the TLS design adaptively updated both the sampling frame and the selection probabilities over time using information acquired from prior weeks. Although the study itself was specific to COVID-19, the strategies presented in this paper could serve as a case study that can be adapted for performing rigorous population-level inferences in similar settings and could help inform rapid and effective responses to future global public health challenges.

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Error rates during blood collection in emergency departments and outpatient clinics: Results of a prospective multicenter study

Cited by 10 publications

References 7 publications

Frequency of icteric interference in clinical chemistry laboratory tests and causes of severe icterus

Frequency of icteric interference in clinical chemistry laboratory tests and causes of severe icterus

Pre-Test and Post-Test Applications to Shape the Education of Phlebotomists in A Quality Management Program: An Experience in A Training Hospital

Adaptive Time Location Sampling for Compass, a Sars-Cov-2 Prevalence Study in Fifteen Diverse Communities in the United States

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