The impact of repeat-testing of common chemistry analytes at critical concentrations

Onyenekwu, Chinelo P; Hudson, Careen L; Zemlin, Annalise E; Erasmus, Rajiv T

doi:10.1515/cclm-2014-0331

Cited by 16 publications

(31 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Survey also revealed that participants do not have an uniform practice regarding consultations with doctors after receiving an information about hemolysed sample. This finding provides additional evidence on harmonization necessity in post-analytical phase ( 12 ), because the issue of automatic resampling might gain specific significance in case of critical values, when a reporting delay may cause adverse outocmes ( 13 ).…”

Section: Discussionmentioning

confidence: 80%

See 1 more Smart Citation

Hemolysis from a nurses’ standpoint – survey from four Croatian hospitals

et al. 2015

View full text Add to dashboard Cite

IntroductionHemolysis can occur during sample collection, handling and transport. It is more frequent when the non-laboratory staff performs sampling. The aim of this study was to assess nurses’ knowledge on the causes of hemolysis and consequential impact on the laboratory tests results. Additionally, the differences in knowledge, related to work experience, professional degree and previous education about hemolysis were explored.Materials and methodsAn anonymus survey, containing 11 questions on demographics, causes of hemolysis, its impact on biochemical parameters and nurses’ attitude towards additional education in preanalytics, was conducted in four Croatian hospitals. The answers were compared by Chi-squared and Fischer exact test.ResultsIn total, 562 survey results were collected. Majority of nurses declared familiarity with the term “hemolysis” (99.6%). There were 77% of correct answers regarding questions about the causes of hemolysis, but only 50% when it comes to questions about interference in biochemical tests. The percentage of correct answers about causes was significantly lower (P = 0.029) among more experienced nurses, and higher (P = 0.027) in those with higher professional degree, while influence of previous education was not significant. Also, higher percentage of correct answers about interferences was encountered in nurses with longer work experience (P = 0.039). More than 70% of nurses declared that additional education about preanalytical factors would be beneficial.ConclusionCroatian nurses are familiar with the definition of hemolysis, but a lack of knowledge about causes and influence on laboratory test results is evident. Nurses are eager to improve their knowledge in this field of preanalytical phase.

show abstract

Section: Discussionmentioning

confidence: 80%

“…In the future, the same questionnaire could be used in evaluating effectivnes and benefits acheived in educational interventions as recommended in the literature ( 13 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

Hemolysis from a nurses’ standpoint – survey from four Croatian hospitals

et al. 2015

View full text Add to dashboard Cite

show abstract

“…5,6 A growing number of publications have addressed the reporting of critical values. 3,[7][8][9][10][11][12] A CAP-sponsored study of 121 institutions determined that it takes a total of 7 minutes for technician to notify clinicians about a critical result once testing was complete. 13 It took up a lot of time reporting thousands of critical values by laboratories each year.…”

Section: Introductionmentioning

confidence: 99%

Enhance the effectiveness of clinical laboratory critical values initiative notification by implementing a closed‐loop system: A five‐year retrospective observational study

Wang

Gong

et al. 2019

Clinical Laboratory Analysis

View full text Add to dashboard Cite

Background Accurate and timely clinical laboratory critical values notification are crucial steps in supporting effective clinical decision making, thereby improving patient safety. Methods A closed‐loop laboratory critical value notification system was developed by a multidisciplinary team of clinicians, laboratorians, administrators, and information technology experts. All the laboratory critical values that occurred at Beijing Tsinghua Changgung Hospital (BTCH, Beijing, China) from 2015 to 2019 were analyzed and studied retrospectively. Results The total number (ratio) of institutional laboratory critical values to all reported items at BTCH from 2015 to 2019 was 38 020/7 706 962 (0.49%). Percentage distribution points of critical value boundaries based on patients’ test reports are 0.007% ~ 6.04% for low boundaries and 71.70% ~ 99.99% for high boundaries. After the intervention, the timely notification ratio, notification receipt ratio, and timely notification receipt ratio of critical values of ED, IPD, and total patients had increased, with a significant difference (P < .001). Five quality indicators, such as notification ratio, timely notification ratio, notification receipt ratio, timely notification receipt ratio, and clinician response ratio over a 5‐year period, were 100%, 94%, 97%, 92%, and 99%, respectively. Conclusions We enhanced the effectiveness of clinical laboratory critical values initiative notification by implementing a closed‐loop system and intervening. Clinical critical values and quality indicators should be analyzed and monitored to avoid adversely affecting patient care.

show abstract

“…Whereas Deetz et al investigated about 3000 observations for calcium, other assays had 100 observations or less ( 22 , 29 ). Onyenekwu et al found 4.9% outliers out of 91 repeats for calcium at critical concentrations also using CAP/CLIA errors limits ( 21 ). Witte et al aimed to identify outliers in the sense of “errors” defined by a multiple SD e.g.…”

Section: Discussionmentioning

confidence: 99%

“…outliers among routine samples, which may cause erroneous clinical decisions in patient care ( 4 - 15 ). To identify outliers, duplicate measurements may be used ( 16 - 20 ), but are often refrained from, due to economic pressure ( 21 , 22 ). …”

Section: Introductionmentioning

confidence: 99%

Analytical robustness of nine common assays: frequency of outliers and extreme differences identified by a large number of duplicate measurements

et al. 2017

View full text Add to dashboard Cite

IntroductionDuplicate measurements can be used to describe the performance and analytical robustness of assays and to identify outliers. We performed about 235,000 duplicate measurements of nine routinely measured quantities and evaluated the observed differences between the replicates to develop new markers for analytical performance and robustness.Materials and methodsCatalytic activity concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and concentrations of calcium, cholesterol, creatinine, C-reactive protein (CRP), lactate, triglycerides and thyroid-stimulating hormone (TSH) in 237,261 patient plasma samples were measured in replicates using routine methods. The performance of duplicate measurements was evaluated in scatterplots with a variable and symmetrical zone of acceptance (A-zone) around the equal line. Two quality markers were established: 1) AZ95: the width of an A-zone at which 95% of all duplicate measurements were within this zone; and 2) OPM (outliers per mille): the relative number of outliers if an A-zone width of 5% was applied.ResultsThe AZ95 ranges from 3.2% for calcium to 11.5% for CRP and the OPM from 5 (calcium) to 250 (creatinine). Calcium, TSH and cholesterol have an AZ95 of less than 5% and an OPM of less than 50.ConclusionsDuplicate measurements of a large number of patient samples identify even low frequencies of extreme differences and thereof defined outliers. We suggest two additional quality markers, AZ95 and OPM, to complement description of assay performance and robustness. This approach can aid the selection process of measurement procedures in view of clinical needs.

show abstract

The impact of repeat-testing of common chemistry analytes at critical concentrations

Abstract: The practice of repeating a critical test result appears unnecessary as it yields similar results, delays notification to the treating clinician and increases laboratory running costs.

Cited by 16 publications

References 4 publications

Hemolysis from a nurses’ standpoint – survey from four Croatian hospitals

Hemolysis from a nurses’ standpoint – survey from four Croatian hospitals

Enhance the effectiveness of clinical laboratory critical values initiative notification by implementing a closed‐loop system: A five‐year retrospective observational study

Analytical robustness of nine common assays: frequency of outliers and extreme differences identified by a large number of duplicate measurements

Contact Info

Product

Resources

About