Preanalytical quality improvement: from dream to reality

Abstract

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.

Preanalytical quality improvement: in quality we trust

“…The prevalence of lipemia is lower than that of other unsuitable specimens such as those clotted or hemolyzed, but still appears in approximately 1 % of samples. Besides pathophysiological conditions, preanalytical laboratory errors account for a large proportion of lipemic samples (i.e., improper time of sampling after a meal or after intravenous infusion of triglycerides-rich emulsions for parenteral nutrition) and, as such, can be prevented [11] .…”

“…Important issues include, e.g., appropriate test requisition, patient preparation, phlebotomy performed outside the laboratory (perhaps by a different staff), sample stability and handling of other sample materials such as saliva, cerebrospinal fluid or sampling from catheters [11] . The issues are complex and widespread, and often the accreditation process tends to focus on the capability of the laboratory production itself.…”

Errors in laboratory medicine: The role of quality indicators

“…Pre-analytical errors account for up to 70% (46-68.2% of total errors) of all mistakes made in laboratory diagnostics, most of which arise from problems in patient preparation, sample collection, transportation, and preparation for analysis and storage. 3,4 Analytical errors are reduced over time after implementation of IQC and EQPs. A high error rate (18.5-47% of total errors) has also been found in the post-analytical phase.…”

Pre Analytical Phase : The Seismic Zone of Clinical Laboratory Testing

“…[3] The preanalytical phase accounts for nearly 70% of the errors in laboratory testing. [4] The preanalytical phase beyond doubt is the most error prone phase but recent data from literature suggests that the errors occurring in the preanalytical phase are mostly related to procedures performed outside the laboratory by health care personnel who are not under direct control of laboratory. [5] For example, we are all aware of effect of hemolysis on serum Potassium concentration.…”