Quality Status of the Preanalytical Phase of Clinical Laboratories in Korea

Abstract

Background: In laboratory medicine, preanalytical errors account for more than half of laboratory errors; however, in Korea, research on preanalytical phase management is lacking. This study revealed the status of preanalytical phase management in Korean clinical laboratories. Methods: Clinical pathologists in Korean hospitals, from secondary to tertiary hospital levels, were surveyed on the major preanalytical factors using an online platform from June 14, 2021, to August 16, 2021. Results: For patient identification before blood collection, 12.5% of the laboratories checked only one factor in unconscious patients. Most laboratories had fasting policies; however, the specifics varied. Specimens are supposed to be labeled in front of the patient; however, this was not always followed in the wards or emergency departments. Only 45.7% of the laboratories checked the time from blood collection to laboratory reception. Moreover, only 75.3% of the organizations evaluated whether blood collection was being performed according to protocol. Most laboratories were found to employ visual confirmation to detect in vitro hemolysis, with less than 40% laboratories using the hemolysis index. The reporting of the hemolysis index was inconsistent, as most organizations did not conduct internal quality control for this parameter. Conclusions: The study established the preanalytical phase status in Korean medical institutions and found that crucial factors, such as fasting regulations, specimen labeling and transportation, time from blood collection to reception, and in vitro hemolysis, were not being managed properly. These results can serve as an essential basis for quality improvement activities in the preanalytical phase.