Quality Indicators for Evaluating Errors in the Preanalytical Phase.
ABSTRACT: Objective The aim of this study was to study the incidence of preanalytical errors in the clinical chemistry laboratory attached to a tertiary care hospital. Design and Methods The study was conducted in a clinical chemistry laboratory using the samples and forms received for analysis. Five hundred random samples were analyzed using a predefined set of quality indicators (QIs) over a period of 3 months. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Statistical Analysis Individual QIs were assigned values as 0 and 1 and were used to assess each sample; 0 if the error was present, and 1 if absent. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Result Out of the 500 samples observed, 138 samples were error free, while 21 samples had the maximum number of errors, that is, 6. The error committed most often was the omission of provisional diagnosis being mentioned on the requisition form. No preanalytical error was observed for QIs: selecting the appropriate blood collection vial or storage of sample. Conclusion This study confirms that error rate in the preanalytical phase is high and vastly ignored. Errors committed here may be overlooked, given the large number of samples received in the clinical laboratory of a tertiary center. To reduce these errors, the laboratory should provide training to all workers involved in the preanalytical phase. Daily or weekly QI scores should be recorded to assess and rectify shortcomings, thereby improving patient care.
Project description:<h4>Objectives</h4>Point of Care Testing (POCT) is a rapidly expanding area of clinical laboratory testing and quality assurance is an important area of focus. Quality indicators (QIs) are a quality management system tool that monitors aspects of the testing process to help meet the challenges associated with maintaining high quality patient safety given the growth in POCT. Alberta aims to formalize the development and use of QIs for POCT.<h4>Design</h4>and Methods: Potential QIs were identified by reviewing both the current standards and guidelines for QIs in POCT, and the research regarding quality and sources of error in POCT. Quality practices and potential sources of error in POCT were identified by: 1) a Canadian national survey on POCT, and 2) direct observation in two local POCT programs.<h4>Results</h4>A proposed selection of QIs in POCT were identified by incorporating the results from these investigations, while considering the unique characteristics of POCT. These QIs monitor the preanalytical, analytical, and post-analytical phases of testing, and support processes.<h4>Conclusions</h4>As POCT volumes and test menu expands, QIs will be a vital tool in monitoring error and maintaining high quality of results. Adoption of formal QIs will support continuous quality improvement and improved patient care.
Project description:Background:The increase of medical laboratory test errors represents the increase of all defects within the process. An error can be any defect during the entire process, from ordering to reporting. It may have negative effects on patient care, by contributing to inappropriate treatment, an increase in lengths of hospital stay, and dissatisfaction with healthcare services. Therefore, this study aimed to determine factors affecting the quality of laboratory results through the entire process. Methods:A cross-sectional study was conducted at Hawassa University hospital from October 2018 to May 2019. Data were collected by using structured questionnaires and checklist and entered and analyzed using SPSS version 21. P-values less than 0.05 were considered statistically significant. Results:A total of 455 individuals participated in this study. During the actual observational assessment, 72.5% of laboratory professionals identify their patients correctly and 62.5% of them label the sample before collection. In multivariate logistic regression, labeling of sample before collection (AOR=1.357, 95% CI=1.09, 1.58, P- 0.017), use of unmixed (AOR=4.364, 95% CI=1.950, 20.036, P- 0.049) and hemolyzed blood for testing (AOR=1.403, 95% CI=1.096, 1.692 P- 0.021) were associated with laboratory test errors. The clinical service providers who requested the test believed, lack of efficient laboratory service (P=0.005), unable to use manuals (P=0.025), and incorrect interpretation of reference booklets were associated with laboratory errors. Patient residence and frequency of first and second visits of the hospital were statistically associated with laboratory errors. Conclusion:The occurrence of laboratory errors in our study was demonstrated by the distribution pattern, the preanalytical, analytical, and post-analytical steps. But changes have occurred in the types and frequencies of errors in these phases of testing by laboratory professionals, clinicians, and patients in the current study. Therefore, the hospital administrations, laboratory professionals and clinicians should work harder and closer to solve the identified problems.
Project description:BACKGROUND:Diagnostic errors causing harm in children are understudied, resulting in a knowledge gap regarding pediatricians' interest in reducing their incidence. METHODS:Electronic survey of general pediatricians focusing on diagnostic error incidence, errors they were interested in trying to improve, and errors reduced by their electronic health record (EHR). RESULTS:Of 300 contacted pediatricians, 77 (26%) responded, 58 (19%) served ambulatory patients, and 48 (16%) completed the entire questionnaire. Of these 48, 17 (35%) reported making a diagnostic error at least monthly, and 16 (33%) reported making a diagnostic error resulting in an adverse event at least annually. Pediatricians were "most" interested in "trying to improve" missed diagnosis of hypertension (17%), delayed diagnosis due to missed subspecialty referral (15%), and errors associated with delayed follow-up of abnormal laboratory values (13%). Among the 44 pediatricians with an EHR, 16 (36%) said it reduced the likelihood of missing obesity and 14 (32%) said it reduced the likelihood of missing hypertension. Also, 15 (34%) said it helped avoid delays in follow-up of abnormal laboratory values. A third (36%) reported no help in diagnostic error reduction from their EHR. CONCLUSIONS:Pediatricians self-report an appreciable number of diagnostic errors and were most interested in preventing high frequency, non-life-threatening errors. There exists a need to leverage EHRs to support error reduction efforts.