European survey on preanalytical sample handling – Part 1: How do European laboratories monitor the preanalytical phase? On behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Pha

Abstract

Introduction: Compared to other activities of the testing process, the preanalytical phase is plagued by a lower degree of standardization, which makes it more vulnerable to errors. With the aim of providing guidelines and recommendations, the EFLM WG-PRE issued a survey across European medical laboratories, to gather information on local preanalytical practices. This is part one of two coherent articles, which covers all practices on monitoring preanalytical quality except haemolysis, icterus and lipemia (HIL). Materials and methods: An online survey, containing 39 questions dealing with a broad spectrum of preanalytical issues, was disseminated to EFLM member countries. The survey included questions on willingness of laboratories to engage in preanalytical issues. Results: Overall, 1405 valid responses were received from 37 countries. 1265 (94%) responders declared to monitor preanalytical errors. Assessment, documentation and further use of this information varied widely among respondents and partially among countries. Many responders were interested in a preanalytical online platform, holding information on various aspects of the preanalytical phase (N = 1177; 87%), in a guideline for measurement and evaluation of preanalytical variables (N = 1235; 92%), and in preanalytical e-learning programs or webinars (N = 1125; 84%). Fewer responders were interested in, or already participating in, preanalytical EQA programs (N = 951; 71%). Conclusion: Although substantial heterogeneity was found across European laboratories on preanalytical phase monitoring, the interest in preanalytical issues was high. A large majority of participants indicated an interest in new guidelines regarding preanalytical variables and learning activities. This important data will be used by the WG-PRE for providing recommendations on the most critical issues.

<p>Factors Affecting Quality of Laboratory Result During Ordering, Handling, and Testing of the Patient’s Specimen at Hawassa University College of Medicine and Health Science Comprehensive Specialized Hospital</p>

“…7,8 The fact that preanalytical processes primarily take place outside the laboratory makes it challenging to establish and implement quality control measures comparable to those used as standard throughout the analytical processes. 9 It also encompasses many different participants such as patients, clinical service providers, management staff, sample transporters, and logistic personnel, who are the possible variables for contributing to the nonconformity of test results. 9 Errors occurring starting from the time of test order from the physician until the sample is ready for analysis can account for up to 70% of the total errors.…”

“…9 It also encompasses many different participants such as patients, clinical service providers, management staff, sample transporters, and logistic personnel, who are the possible variables for contributing to the nonconformity of test results. 9 Errors occurring starting from the time of test order from the physician until the sample is ready for analysis can account for up to 70% of the total errors. 10 Errors at any stage of ordering, collection, testing, and reporting can lead to severe patient misdiagnosis.…”

Exact time of venous blood sample collection – an unresolved issue, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)

“…The results discussed in this paper are a part of a larger survey, carried out by the EFLM WG-PRE between October 1st and November 30th 2017 [10,11]. The study aimed to investigate how European laboratories are currently dealing with preanalytical sampling handling in general, as well as with hemolysis, icterus and lipemia interference, in particular.…”

“…Therefore, major efforts should be made to improve the quality of this information, thus developing reliable tools for improving current practices, especially in those centers where this aspect may be partly (or completely) overlooked or underestimated. Hence, this study is aimed to present the unpublished part of the results of a previous EFLM survey [10,11], and provide an overview and discussion on possible solutions to better address the issue of sampling time registration.…”

The preanalytical phase – Past, present and future

“…18 The ACB WG PRE reviewed the various options for collecting data, recommending that when possible the laboratory information management system should be used as the recording tool. 20 Even for the most commonly assessed preanalytical indicator, the Haemolysis, Icteric, Lipaemic (HIL) indices, there is significant variation in how the results of these indices are handled, ranging from simply documenting the findings through to rejecting the whole sample. From these studies, it is hoped that best practice guidelines will emerge so that the process can either be harmonized, or at the very least ensure the there is a robust evidence base to support the approach of an individual laboratory.…”