Taking Aim at Pre-analytical Errors

Any error during the laboratory testing process has the potential to dramatically impact patient care. A single error can lead to a series of adverse effects that include repeated tests, delays in treatment, misdiagnoses, and in worst case scenarios, harm to the patient. Compounding this reduction in patient safety and satisfaction, errors also directly lead to increased health care costs. With patient care paramount, improving error rates is the responsibility of the entire health system.

Typically, errors are viewed across the total testing process (TTP). TTP is comprised of three stages:

1. Pre-analytical—all processes prior to the testing of a specimen
2. Analytical—all processes during the testing of a specimen
3. Post-analytical—all processes involved after test analysis

Laboratory medicine has led the way in reducing error rates in clinical diagnostics, with studies of stat labs showing an estimated error rate of just 0.33 percent. However, because pre-analytical tasks are not performed under the control of laboratory personnel, they can be more challenging to directly improve. The lab has a responsibility to work with all other health care professionals involved in identification, data entry, specimen collection and transport to ensure the safety of patients.

Laboratories that take a leadership role in the adoption of best practices in order to improve specimen integrity can help by improving the procedures, processes, and products in the pre- and post-analytical phases, and not just those under direct laboratory control.

The problem of pre-analytical errors

Errors in the pre-analytical phase, which encompasses collection, transport and storage, processing, and other patient variables, accounts for up to two-thirds of all errors observed during the TTP. A large percentage of these errors fall under the umbrella of collection, with insufficient specimen quality and quantity accounting specifically for more than 60 percent of errors in the pre-analytical phase. On average three percent of all blood culture tests conducted in US for sepsis and other bloodstream infections are false-positive due to contamination. This amounts to over 1 million patients at risk of misdiagnosis for sepsis every year.

Ensuring quality control through best practices 

Fortunately, the lab can help address pre-analytical errors by assessing collection procedures and implementing quality procedures and products across the collection process. Even small quality improvements in specimen collection practices can greatly improve patient care and satisfaction.

Regular assessment of collection procedures and products is the path to long-term success in minimizing error rates. In addition, there are best practices that facilities can implement to help ensure quality. These include:

• Educating personnel from all units of the health care team involved in the specimen collection and transport process to ensure consistency and adherence to procedures
• Maintaining detailed plans for assessing quality indicators at every step of the process and addressing issues when they arise
• Standardizing products and utilization protocols in order to streamline SKU management, reduce costs, and simplify training
• Employing custom collection kits to adhere to standardization and collection protocols, as well as minimize contamination and false positives

Contaminated specimens do not have to be an inevitable occurrence. Even those facilities already maintaining low error rates can still make meaningful strides in specimen integrity. With a clear plan that includes quality control best practices, health care team members working toward the same goal, and suppliers that share your commitment to quality, success is achievable.