Reducing Preanalytical Errors through Patient Education

The preanalytical phase covers a broad spectrum of activities, including patient preparation, sample collection, transport, and processing. Notably, it accounts for up to 75 percent of laboratory errors. Proper patient education and preparation is essential to maintaining the integrity and quality of sample results. 

This article explores how clinical labs can empower patients with the right knowledge to minimize preanalytical errors, ultimately enhancing the reliability of lab results.

Patient engagement leads to better health care

Patient education involves influencing patient behavior and conveying the knowledge, attitudes, and skills necessary to maintain or improve health. “Educating patients about their role in the preanalytical phase is crucial, as their choices and behaviors can significantly influence the accuracy and reliability of the test outcomes,” says Charlie Paterson, clinical development expert at PA Consulting. “Errors in the preanalytical process introduce risks for the patient, hinder the study's validity (for pre-approval products), create unnecessary waste, and drive up system costs.”

Common patient-related preanalytical errors include medication interference, improper specimen collection, and inadequate fasting. For example, consider a lipid profile test, which requires patients to fast for 12 hours for accurate results. A patient who misunderstands or forgets these instructions may eat before the test, leading to inaccurately high lipid levels. Similarly, inadequate specimen collection, such as insufficient urine volume or contamination, can lead to false results or the need for repeat testing. 

These patient-related incidents are far from rare. In a study surveying outpatient cases—primarily individuals over 65 years of age with chronic diseases—patients improperly collected a 24-hour urine sample in more than half of the cases. Patients did not follow the prescribed instructions, discarded part of the urine sample, or used an improper container. When such errors in sample collection occur, the entire process must be repeated.

Effective strategies for patient education

Educating the patient to reduce preanalytical errors goes far beyond only explaining the practical aspects of urine or blood sampling. Lab personnel must emphasize the effect of possible biological confounders, such as dietary intake, diuresis, exercise, medication, and other interferents. 

Information needs to be specific and uncomplicated. If delivered verbally, labs can reinforce in-person conversations with written or illustrated instructions. Ideally, patients would also receive written guidelines, such as a preparatory “dos and don'ts” list for their blood test, either attached to their test requests or distributed by healthcare professionals. 

“Partnering with physicians and direct physician-to-patient engagement in a bi-directional discussion results in positive outcomes when the sample is collected close to the time of the consultation,” says Paterson. “However, as the time between discussion and sample collection increases, there is a greater need to use alternatives to drive compliance.”

Different patient groups may require different approaches. Elderly patients might benefit from larger print materials, while younger patients might engage more with digital platforms. Remember that patients have different learning styles, so you can ask if your patient learns best by watching a video or reading. 

Paterson highlights the evolution of patient education methods. He notes that while written materials supported by scheduled SMS prompts have been effective, technological advancement is introducing more targeted and interactive solutions. “Options are expanding to include web chat and SMS chat functions, allowing patients to respond to prompts or connect with real or virtual agents to explore questions or concerns.”

Looking ahead, Paterson foresees a trend toward highly personalized patient education. "As technologies advance, we expect to see the automatic generation of guides tailored to a patient's specific schedule and needs,” he says. “This will involve the automatic creation of scripts in various languages and their translation into video, all achievable with just a few clicks.”

The role of training and shared responsibility 

Training lab personnel to communicate effectively with patients is crucial in patient education initiatives. This includes training on how to explain procedures, answer queries, and provide clear instructions. Clinical labs aspiring to implement training initiatives on patient education should adopt a multifaceted approach, including the following:

• Customized education: Tailor the education to fit each patient's level of understanding, cultural background, and previous experiences. This customization makes the information more relatable and easier to grasp.
• Conducive learning environment: Create an atmosphere of trust and respect. This fosters better engagement and makes patients feel comfortable and valued.
• Relevance: Only present material directly relevant to a patient's needs.
• Interactive learning: Offer opportunities for patients to demonstrate their understanding. This reinforces their knowledge and helps them gain confidence in managing their health.

Beyond training lab personnel, fostering a culture of shared responsibility among all allied healthcare providers contributes to the effectiveness of patient education. For example, regular discussions and updates between lab staff and clinicians or nurses can ensure that all parties are aligned on the best practices for patient preparation and understand their roles in minimizing preanalytical errors. This approach also enhances the overall patient experience, as patients feel more informed and confident about their lab test results.

Measuring the impact of patient education

Assessing the impact of patient education initiatives is key to understanding their effectiveness. Clinical labs can do this by tracking changes in the rates of specimen rejection and preanalytical errors. A decrease in these rates can serve as a quantitative indicator of success. 

Surveys and feedback sessions with patients and lab staff provide qualitative insights into the effectiveness of educational programs and make it easy to highlight areas for improvement. In addition, documenting case studies as evidence of how patient education has directly decreased errors can help further communicate the value of educational initiatives. 

Time and the human factor: essential elements in the educational process

To realize the benefits of patient education in complying with testing protocols, clinical labs must invest time and energy into these initiatives. Educating patients effectively is not a one-time effort but a continuous process that involves regular verbal, written, and/or visual guidances to understand and adhere to pre-test requirements.

And remember: the journey to minimizing preanalytical errors is not only a technical challenge but a human one that requires compassion, understanding, and empathy.