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Lab Errors Rare in the Analytic (i.e., Intra-Laboratory) Phase of Testing

Posted May 05 2014 12:00am

The majority of lab errors occur in what are commonly called the preanalytic and postaalytic phases of testing and not in the analytic phase. This latter phase takes place within the walls of the clinical labs; any errors occurring in this time frame would be attributable to lab personnel. These three phases of lab testing were discussed in a recent article (see: Don't blame the lab: Most lab errors are clinicians' fault ). Below is an excerpt from it:

Laboratory errors" only occur in the lab about 4% of the time, according to a new ECRI Institute report that suggests many clinicians don't realize their role in creating errors. For the report, the ECRI Institute analyzed 2,420 laboratory and radiology errors that occurred between 2011 and mid-2013 at 52 U.S. hospitals. While participating hospitals attributed 25% of the errors to the lab, researchers found that only 4% of potentially harmful errors occurred in the lab. Specifically, researchers determined [that] [n]early 75% of errors occurred in the pre-analytic stage (when tests were selected, ordered, identified, and transported); and about 22% of errors occurred in the post-analytic stage (when tests were interpreted, reported, and stored). Additionally, researchers found most pre-analytic stage errors were associated with clinicians labeling tests with the wrong patient's name, ordering the wrong specimen, or not filling out information correctly. Most post-analytic mistakes were associated with missing results or when clinicians delayed getting results to clinicians who ordered them. Misdiagnoses affect one in 20 outpatient visits, BMJ study finds ....The report recommended that hospitals research how to break down silos between units of testing and conduct analyses on where communication breakdowns occur,

It it should come as no surprise that errors in the analytic phase of testing are uncommon. Some of the reasons for this are the following: (1) most lab testing is performed by large-scale, highly automated analyzers integrated with robust quality control procedures; (2) all test results are  managed by LISs, again with internal control processes and a high degree of automation; (3) there is a pervasive quality culture among lab processionals with no toleration for errors; (4) lab accreditation is based, in part, on the quality and accuracy of lab test results generated by a lab. By way of contract, the preanalytic and postanalytic steps take place in the labor-intensive inpatient and outpatient settings that can be hectic compared to the more calm lab settings. A not unexpected conclusion from all of this is that most attention regarding the elimination of lab testing errors needs to be concentrated on the various clinical environments and not in the labs.

The notion of "breaking down silos" in hospitals to reduce preanalytic and postanalytic errors referred to in the excerpt above is easier said than done. I was in charge of the phlebotomy team for a number of years. In one case, I worked with the nursing service to effect a small change in the nursing procedure manual regarding the inspection of a patient ID bracelet prior to the labeling of a blood specimen. Everyone involved agreed that the change was necessary and appropriate but it took about six months to make the change in the nursing procedure manual. Lab test reporting these days has also been made much more complicated with the deployment of EHRs such that some changes require software rather than procedural modifications.

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