The economic impact of poor sample quality in clinical chemistry laboratories: results from a global survey

Abstract

Background Despite advances in clinical chemistry testing, poor blood sample quality continues to impact laboratory operations and the quality of results. While previous studies have identified the preanalytical causes of lower sample quality, few studies have examined the economic impact of poor sample quality on the laboratory. Specifically, the costs associated with workarounds related to fibrin and gel contaminants remain largely unexplored. Methods A quantitative survey of clinical chemistry laboratory stakeholders across 10 international regions, including countries in North America, Europe and Oceania, was conducted to examine current blood sample testing practices, sample quality issues and practices to remediate poor sample quality. Survey data were used to estimate costs incurred by laboratories to mitigate sample quality issues. Results Responses from 164 participants were included in the analysis, which was focused on three specific issues: fibrin strands, fibrin masses and gel globules. Fibrin strands were the most commonly reported issue, with an overall incidence rate of ∼3%. Further, 65% of respondents indicated that these issues contribute to analyzer probe clogging, and the majority of laboratories had visual inspection and manual remediation practices in place to address fibrin- and gel-related quality problems (55% and 70%, respectively). Probe maintenance/replacement, visual inspection and manual remediation were estimated to carry significant costs for the laboratories surveyed. Annual cost associated with lower sample quality and remediation related to fibrin and/or gel globules for an average US laboratory was estimated to be $100,247. Conclusions Measures to improve blood sample quality present an important step towards improved laboratory operations.

Switching from serum to plasma: Implementation of BD Vacutainer® Barricor™ Plasma Blood Collection Tubes improves sample quality and laboratory turnaround time

“…Standard serum tubes require time to allow blood to clot and are contraindicated for use in patients on anticoagulant therapy. Insufficiently-clotted serum samples can lead to the formation of fibrin strands or masses that can interfere with sensitive immunoassay binding and contribute to clogging of analyzer probes [1,2]. Fibrin strands have a reported incidence rate of 2.8% in blood samples [2].…”

“…Sample quality issues due to fibrin or gel can interfere with automated sample processing and often require manual remediation. This utilizes healthcare worker time and hospital resources, which can have a significant effect on clinical laboratory performance, including test turnaround time (TAT) [2]. In most laboratories, TAT is defined as the time between laboratory registration and result reporting.…”

Preanalytical Errors in Clinical Biochemistry Laboratory and Relationship With Hospital Departments and Staff: A Record-Based Study

“…The high preanalytical rejection rate we found indicates that healthcare personnel other than laboratory professionals cause the vast majority of laboratory errors. In many countries, the results of preanalytical errors reaching 4 to 6 times of analytical or postanalytical errors were determined and studies on error minimization were initiated 7,10,11,13 . The working group for the preanalytical phase of the European Union has been carrying out many projects since 2013, such as harmonizing the definition of fasting status, identification of patients and blood tubes, color coding of blood collection tubes, and sequencing and development of tubes during blood collection 18 .…”

“…Failure to detect these errors has a potential risk of harm, as it may lead to misdiagnoses or erroneous assessments 6 . Delayed and inaccurate laboratory results cause delayed or incorrect diagnosis and treatment and increase hospital costs 7,8 . The mean cost of preanalytical errors was estimated at $162 for inpatient critical, $357 for inpatient noncritical, and $337 for outpatient including emergency department (ED) patients in North American hospitals 3,6,8 …”

Survey of patient perception of pre-analytical requirements for blood testing in the UK and RoI

“…All of these may negatively impact the patient experience, clinical outcome and compromise patient safety. 4 Therefore, it is vital that clinical laboratory results are of the highest possible quality.…”