Errors in laboratory medicine and patient safety: the road ahead

Plebani, Mario

doi:10.1515/cclm.2007.170

Cited by 113 publications

(67 citation statements)

References 62 publications

(37 reference statements)

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“…Plebani mentions in his review that the error rate has been decreasing steadily over time (3,4). In our experience, it is very difficult to change the behaviour of personnel that are not trained in laboratory practice.…”

Section: Discussionmentioning

confidence: 92%

Error tracking in a clinical biochemistry laboratory

Szecsi¹,

Ødum

2009

Clinical Chemistry and Laboratory Medicine

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Background: We report our results for the systematic recording of all errors in a standard clinical laboratory over a 1-year period. Methods: Recording was performed using a commercial database program. All individuals in the laboratory were allowed to report errors. The testing processes were classified according to function, and errors were classified as pre-analytical, analytical, post-analytical, or service-related, and then further divided into descriptive subgroups. Samples were taken from hospital wards (38.6%), outpatient clinics (25.7%), general practitioners (29.4%), and other hospitals. Results: A total of 1189 errors were reported in 1151 reports during the first year, corresponding to an error rate of 1 error for every 142 patients, or 1 per 1223 tests. The majority of events were due to human errors (82.6%), and only a few (4.3%) were the result of technical errors. Most of the errors (81%) were preanalytical. Of the remainder, 10% were analytical, 8% were post-analytical, and 1% was service-related. Nearly half of the errors (ns550) occurred with samples received from general practitioners or clinical hospital wards. Identification errors were relatively common when non-technicians collected blood samples. Conclusions: Each clinical laboratory should record errors in a structured manner. A relation database is a useful tool for the recording and extraction of data, as the database can be structured to reflect the workflow at each individual laboratory.

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Section: Discussionmentioning

confidence: 92%

Error tracking in a clinical biochemistry laboratory

Szecsi¹,

Ødum

2009

Clinical Chemistry and Laboratory Medicine

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“…In a patient centred approach to the delivery of healthcare services, it is thereby necessary to investigate throughout the total testing process any possible defect that may produce adverse impacts on the patient. In fact, in the interests of patients, any direct or indirect negative consequence related to a laboratory test must be considered, irrespective of which step is involved and whether the error depends on a laboratory professional (e.g., calibration or testing error) or a non-laboratory operator (e.g., inappropriate test request, error in patient identification and/or blood collection) (1,16). Patient misidentification, which affects the delivery of all diagnostic services, is widely recognized as the main goal for quality improvement, and some international initiatives aim at improving this aspect.…”

Section: Errors In Laboratory Diagnosticsmentioning

confidence: 99%

Preanalytical quality improvement: from dream to reality

Lippi

Chance

Church³

et al. 2011

Clinical Chemistry and Laboratory Medicine

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280

187

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Laboratory diagnostics (i.e., the total testing process) develops conventionally through a virtual loop, originally referred to as ''the brain to brain cycle'' by George Lundberg. Throughout this complex cycle, there is an inherent possibility that a mistake might occur. According to reliable data, preanalytical errors still account for nearly 60%-70% of all problems occurring in laboratory diagnostics, most of them attributable to mishandling procedures during collection, handling, preparing or storing the specimens. Although most of these would be ''intercepted'' before inappropriate reactions are taken, in nearly one fifth of the cases they can produce inappropriate investigations and unjustifiable increase in costs, while generating inappropriate clinical decisions and causing some unfortunate circumstances. Several steps have already been undertaken to increase awareness and establish a governance of this frequently overlooked aspect of the total testing process. Standardization and monitoring preanalytical variables is of foremost importance and is associated with the most efficient and well-organized laboratories, resulting in reduced operational costs and increased revenues. As such, this article is aimed at providing readers with significant updates on the total quality management of the preanalytical phase to endeavour further improvement for patient safety throughout this phase of the total testing process.

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“…A body of recent evidence highlights that most errors in the " brain-to-brain loop " fall into neither the analytical phase nor the pre-and post-analytical steps under the control and/or jurisdiction of laboratory professionals [2,4,5] . In the last few decades, improvement in the reliability and standardization of analytical techniques, reagents and instrumentation, as well as advancement in information technology, quality control and assurance methodologies have decreased the analytical error rate by several-fold.…”

Section: Introductionmentioning

confidence: 99%

Towards harmonization of quality indicators in laboratory medicine

Plebani

Chiozza²,

Sciacovelli

2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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The identification of reliable quality indicators (QIs) in the total testing process (TTP) represents a crucial step in enabling users to quantify the quality of laboratory services, but the current lack of attention to extra-laboratory factors is in stark contrast with the body of evidence showing the multitude of errors that continue to occur in the pre-and post-analytical phases. Although interesting programs on indicators of the extra-analytical phases have been developed in some countries, there is no consensus on the production of joint recommendations for the adoption of universal QIs and the use of common terminology in the total testing process. In view of the different QIs and terminologies currently used, there an urgent need to harmonize proposed QIs, which should comply with three main principles: they must be patient-centered, consistent with the requirements of the International Standard for medical laboratories accreditation, and address all stages of the TTP. A model of quality indicators (MQI), consensually developed by a group of clinical laboratories according to a project launched by a working group of the International Federation of Clinical Chemistry and Labo ratory Medicine (IFCC), includes 56 QIs related to key processes (34 pre-, 7 intra-and 15 postanalytical phase) and three to support processes. The scope of harmonization in laboratory medicine, more far-reaching than method harmonization, should cover a wider range of topics, namely all steps of the " brain-to-brain loop " . The identification of valuable QIs is a key step in paving the way towards quality and patient safety in laboratory medicine.

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Errors in laboratory medicine and patient safety: the road ahead

Cited by 113 publications

References 62 publications

Error tracking in a clinical biochemistry laboratory

Error tracking in a clinical biochemistry laboratory

Preanalytical quality improvement: from dream to reality

Towards harmonization of quality indicators in laboratory medicine

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