Journal Information
Journal ID (publisher-id): BM
Journal ID (nlm-ta): Biochem Med
Title: Biochemia Medica
Abbreviated Title: Biochem. Med.
ISSN (print): 1330-0962
ISSN (electronic): 1846-7482
Publisher: Croatian Society of Medical Biochemistry and Laboratory Medicine
Article Information
Copyright: 2015, Croatian Societey of Medical Biochemistry
Date received: 16 September 2014
Date accepted: 13 June 2015
Publication date (electronic): 15 October 2015
Publication date (print): 15 October 2015
Volume: 25
Issue: 3
Pages: 377-385
Publisher ID: bm-25-377
DOI: 10.11613/BM.2015.037
Specimen rejection in laboratory medicine: Necessary for patient safety?
Author notes:
Corresponding author: zgunnur@gmail.com
Introduction
The emergency laboratory in Hacettepe University Hospitals receives specimens from emergency departments (EDs), inpatient services and intensive care units (ICUs). The samples are accepted according to the rejection criteria of the laboratory. In this study, we aimed to evaluate the sample rejection ratios according to the types of pre-preanalytical errors and collection areas.
Materials and methods
The samples sent to the emergency laboratory were recorded during 12 months between January to December, 2013 in which 453,171 samples were received and 27,067 specimens were rejected.
Results
Rejection ratios was 2.5% for biochemistry tests, 3.2% for complete blood count (CBC), 9.8% for blood gases, 9.2% for urine analysis, 13.3% for coagulation tests, 12.8% for therapeutic drug monitoring, 3.5% for cardiac markers and 12% for hormone tests. The most frequent rejection reasons were fibrin clots (28%) and inadequate volume (9%) for biochemical tests. Clotted samples (35%) and inadequate volume (13%) were the major causes for coagulation tests, blood gas analyses and CBC. The ratio of rejected specimens was higher in the EDs (40%) compared to ICUs (30%) and inpatient services (28%). The highest rejection ratio was observed in neurology ICU (14%) among the ICUs and internal medicine inpatient service (10%) within inpatient clinics.
Conclusions
We detected an overall specimen rejection rate of 6% in emergency laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 2%, improve total quality management of the emergency laboratory and promote patient safety.
Keywords: clinical laboratory services; total quality management; patient safety; preanalytical phase; preanalytical error
