About the author amitava dasgupta received his phd degree in chemistry from stanford university and his fellowship training in clinical chemistry from the laboratory medicine department of. Mar 26, 20 laboratories have a major impact on patient safety as 8090 % of all the diagnosis are made on the basis of laboratory tests. Diagnostic errors and laboratory medicine causes and. Practical, easytouse guide to interference issues across all types of clinical laboratory tests for both clinicians and clinical laboratory scientists. Feb 15, 2014 preanalytical errors contd order of draw. Module 5 postanalytical phase of laboratory testing once an accurate test result is obtained the lab must report the result in a timely manner by. There are preanalytical, analytical and post analytical factors that contribute to accurate test results in clinical laboratories. Sometime people quote a statistic that 40% of the errors in the laboratory are preanalytical, 40% are postanalytical, and only 20% are analytical. Preanalytical aspects of laboratory testing sciencedirect. With improvements in analytical techniques and efficient quality control programmes, most laboratory errors now occur in the extraanalytical phases. This approach, however, is not consistent with the concept.
Advances in instrument technology and automation have simplified tasks in laboratory diagnostics and improved the quality of test results. External quality control purpose to survey or test lab proficiency by periodically providing test specimens of unknown concentrations. Compared with other types of medical error, however, errors in laboratory medicine have received little attention. Preanalytical errors and their impact on tests in clinical laboratory practice pakistan journal of medical research, 2012 january march 29 phlebotomy practices should be adopted by all health care workers.
Reducing preanalytical laboratory sample errors through. Evaluation of analytical errors in a clinical chemistry laborat. Is phlebotomy part of the dark side in the clinical laboratory. Currently, preanalytical errors account for up to 70% of all mistakes made in laboratory diagnostics, most of which arise from problems in patient preparation, sample collection, transportation, and preparation for analysis and storage. Clinical practice guidelines clinical practice guidelines. Thus, only analytical and some preanalytical errors those affecting the socalled within laboratory preanalytical steps were detected. According to this concept, all phases and activities of. First of all, poct testing is usually performed by clinical staff i. Moushumi saikia, department of clinical laboratory at apollo hospitals. The interpretation of clinical laboratory test results michael schaer, dvm, diplomate acvim, acvecc university of florida, college of veterinary medicine with the advent of modern medical technology, the availability of hematological and serum biochemical data to the veterinary practitioner has become commonplace. Laboratory diagnostics, a pivotal part of clinical decision making, is no safer than other areas of healthcare, with most errors occurring in the manually intensive preanalytical process.
Laboratory screening and diagnostic tests for prevention and health care improvement american clinical laboratory association and advanced medical technology association, september, 2009. Preanalytical errors in laboratory their consequences and. A look at preanalytical error rates, 2014 westgard. Evaluation of analytical errors in a clinical chemistry laboratory. Preanalytical errors and their impact on tests in clinical. For medical laboratory technology students introduction to medical laboratory technology berhanu seyoum.
Laboratory data are broadly used in medical practice thus laboratory errors have a great impact on patient safety. Identification of the types of preanalytical errors in the. This thoroughly updated second edition of clinical laboratory medicine provides the most complete, current, and clinically oriented information in the field. Laboratories have a major impact on patient safety as 8090 % of all the diagnosis are made on the basis of laboratory tests. Preanalytical errors are quite frequent in the area of pointofcare testing poct. Presidents council of advisors on science and technology, priorities for personalized medicine washington, dc.
Most errors affecting laboratory test results occur in the preanalytical phase, primarily because of the difficulty in achieving standardized procedures for sample collection. Analytical errors rates has decreased significantly as a result of standardization, automation and technological advancement thus improving the analytical reliability of laboratory tests. Mario plebani department of laboratory medicine, university hospital of padova and center of biomedical research, castelfranco veneto, italy abstract laboratory testing is a highly complex process and, although laboratory services are relatively safe, they. The information yielded from the semistructured interviews provided management and health care personnel with an avenue to reduce laboratory errors. According to bd and clsi clinical and laboratory standards institute, formerly nccls, following is the correct order of draw during venipuncture will help to ensure accurate test results. Currently clss are the only individuals licensed by the state of california to perform highcomplexity tests for the diagnosis of. Errors in the extraanalytical phases of clinical chemistry. Review of medical errors in laboratory diagnostics and where. Preanalytical variables and factors that interfere with the.
Using an electronic process allowing for acceptable results to be transmitted electronically via an interface between the analyzer and lab information systemlis and then via another interface between the lis and the electronic medical. Pdf errors in clinical laboratories or errors in laboratory. Manual of laboratory and diagnostic tests 7th fischbach. Errors in clinical laboratories or errors in laboratory. The focus is on the experience of a working group of the international federation of clinical chemistry and laboratory medicine ifcc in developing a model of. To evaluate the leading causes of preanalytical errors in a clinical chemistry laboratory. Nevertheless, it is clear that even the worst medical errors might be preventable if we move to another dimension, considering the system rather than individual errors and learning from them instead of always trying to find someone who is guilty. Failure to follow up on the test, or to discuss their needs with the lab. Reducing preanalytical laboratory sample errors through educational and technological interventions rosa lillo 1, maria salinas 1, maite lopezgarrigos 1, yurena naranjosantana 1, mercedes gutierrez 1, maria dolores marin 1, manuel miralles 1, joaquin uris 2 1 clinical laboratory department, university hospital of san juan, alicante, spain. The preanalytical phase processes that occur before a specimen is analyzed up to 75% of all testing errors occur in the preanalytical phase preanalytical errors can cause harm to patient. Discuss the clinical impact of preanalytical errors on cooximetry testing summarize the evaluation of oxygenation measurement technologies, methods, and measured vs. Effects of preanalytical variables on clinical laboratory tests. It seems that people want to believe that analytical errors arent as frequent as the preanalytical and postanalytical errors. Preventing the patient from experiencing detrimental physical or emotional effects caused by laboratory errors will.
Clinicians do not like dealing with errors despite the importance of recognising and minimising errors in clinical practice. Diagnostic errors and laboratory medicine causes and strategies. Reducing preanalytical errors whitehat communications. Materials and methods we describe the frequency of preanalytical, analytical and postanalytical errors observed in our clinical chemistry laboratory in govind ballabh pant hospital during a 1year period. Science 4th edition anna ciulla pdf success in clinical laboratory science 4th edition anna ciulla are a good way to achieve details about operating certainproducts. The sigmametrics here are quite good, definitely a marked improvement over the first sigmametric assessment by nevelainen et al in 2000. Clinical biochemistry preanalytical aspects of laboratory. Quality indicators to detect preanalytical errors in. Causes, consequences, detection, and prevention of. These factors are difficult to comintor and manage because most occur outside the laboratory. Precautions to be taken to avoid laboratory errors collection of sample at appropriate time. It is very common practice to treat the patient without clinical diagnosis.
Jul 01, 2016 major advances in automation and instrumentation have helped reduce laboratory associated errors over the last decade, but with preanalytical errors currently accounting for up to 75% of all mistakes, laboratory medicine professionals must keep expanding their focus to what is happening outside of the lab. The potential to affect assays and proposed verification and validation processes for the clinical laboratory. Our clinical biochemistry laboratory serves a 600beded tertiary hospital. Jul 31, 2015 analytical and post analytical errors in laboratory 1. Through this video she explained about analytical errors in clinical laboratory which affects patients safety. Errors in medicine and errors in laboratory medicine. Several studies have documented that most of the errors in the clinical laboratory occur in the pre analytical phase accounting up to 80% 2,4,6, 8, 9. Reengineering laboratory diagnostics for preventing preanalytical errors. Evaluation of analytical errors in a clinical chemistry. There are more p errors than a errors, therefore, many laboratories believe they should put a higher priority on pre and postanalytical errors than on analytical errors. The total testing process consists of various phases from the prepreanalytical to the postpostanalytical phase, the socalled braintobrain loop. Measurement of errors in clinical laboratories springerlink.
Errors in laboratory medicine pierangelo bonini,1,2 mario plebani,3 ferruccio ceriotti,2 and francesca rubboli2 background. Review of medical errors in laboratory diagnostics and. Keywords preanalytical errors, quality indicators, laboratory errors, patient safety accepted. Consequently the frequency of errors in clinical lab. We will concentrate on the preanalytical errors which include specimen type selection, blood collection, blood collection equipments and the factors in terfering with biochemical tests. A retrospective analysis of the results obtained from the clinical chemistry laboratory for errors in the preanalytical phase has been carried out to summarize data regarding the frequency of the main factors affecting the preanalytical quality of results. The frequency of laboratory errors during the postanalytical phase is lower.
There has been recent interest in these errors with numerous publications highlighting their. Accurate results in the clinical laboratory 2nd edition elsevier. Efficient laboratory service is the cornerstone of modern health care systems. The clinical laboratory improvement act 1988 to make clinical lab testing subject to the. Clinical chemistry, urinalysis, immunology, serology, histopathology, immunohematology and molecular. Quality indicators to detect preanalytical errors in laboratory testing.
Medical errors account for 98 000 deaths in us hospitals each year. A 3 year experience sakyi as 1, 2, laing ef 1, 2, ephraim rk 3, asibey of 2, sadique ok 2 1 department of molecular medicine, school of medical sciences, college of health sciences, kwame nkrumah university of science and technology, ghana. Preanalytical variables account for 3275% of laboratory errors, and encompass the time from when thetest is ordered by the physician until the sample is ready for analysis. Studies indicate that preanalytical errors contribute a major proportion of errors in laboratory processes and contribute to a number of risks related to the patient safety. For medical laboratory technology students introduction to medical laboratory technology berhanu seyoum haramaya university in collaboration with the ethiopia public health training initiative, the carter center, the ethiopia ministry of health, and the ethiopia ministry of education december 2006.
Preanalytical variables and factors that interfere with. In 2008 to 2009, chawla and colleagues performed a 1year study in the clinical chemistry laboratory on the frequency of preanalytical errors observed in both inpatients and outpatients. Society of medical biochemistry and laboratory medicine csmblm. In fact, it is estimated that 75 % of all laboratory medicine errors are preanalytical errors 2. Thus, errors with laboratory tests might lead to inappropriate medical decisionmaking. The focus of journal articles on preanalytical improvement has reaped a tangible reward. Since, clinical laboratory results play an important role in patients diagnosis, investigation and treatment. According to several studies, a large number of errors involving laboratory medicine happen during the preand postanalytical testing phases 1. Read online now success in clinical laboratory science 4th edition anna ciulla ebook pdf at our library. Most errors affecting laboratory test results occur in the pre analytical phase 4668.
Lippi g, blanckaert n, bonini p, green s, kitchen s, palicka v, et al. Laboratory errors can be defined as any defect from ordering tests to reporting results and appropriately interpreting and reacting on these. Preanalytical errors in laboratory their consequences. Preanalytical errors and their impact on tests in clinical laboratory. Errors in clinical laboratories or errors in laboratory medicine. Figure 1 shows the current stratification of errors in laboratory medicine and their distribution within the different phases of the testing process. Conclusion the quality of the analytical phase increased due to the interest, tight control and following the quality. False assumptions that the test results would be back any minute. Clinical laboratory scientist training program what is a clinical laboratory scientist cls.
Medical laboratory managers success with preanalytical errors. Factors that occur prior to testing the patient specimen. Transcription errors are the greatest single cause of errors in the lab. Lipemic samples lipemic samples are often seen following collection after heavy meals or the due to pre existing metabolic.
Preanalytical variables account for 3275% of laboratory errors, and encompass the time from when the test is ordered by the physician until the sample is ready. A report by bonini and colleagues found that preanalytical errors predominated in the laboratory, ranging from 31. Analytical and post analytical errors in laboratory. Analytical and postanalytical error in clinical chemistry laboratory hanisha erica p. Diagnostic errors and laboratory medicine causes and strategies and clinical laboratories, although not consid ered an analytical error in the strict sense. The clinical laboratory improvement act 1988 to make clinical lab testing subject to the same legal reqs.
Medical laboratory managers success with preanalytical errors by huong ly mba, ellis university, 2010 bs, state university of new york at plattsburgh, 1997 doctoral study submitted in partial fulfillment of the requirements for the degree of doctor of business administration walden university april 2017. The problem of medical errors has recently received a great deal of attention, which will probably increase. Management of the quality in the preanalytical phase. Mario plebani, laura sciacovelli, ada aita, michela. Patient safety is a managerial issue which can be enhanced by implementing active system to identify and monitor quality failures.
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