Enhancing Preanalytical Quality Assurance: Evaluating Blood Sample Rejections and Impact of Targeted Training in a Diagnostic Laboratory Affiliated to a Teaching Medical Institute

Abstract

Purpose: Sample rejection is an important quality indicator pertaining to the preanalytical phase of a laboratory workflow and has a wide range of implications. This study is aimed to determine causes of blood sample rejection, identify areas with maximum rejects and assess impact of targeted training on the same. Methods: A prospective analytical cross-sectional study was conducted in a diagnostic laboratory of a tertiary care hospital. Blood samples collected for clinical biochemistry and hematology tests were monitored for rejections. The study was divided into three phases, in Phase I, rejection rates were monitored without any targeted training, in phase II training was given to phlebotomists in areas of rejection. In phase III, targeted training was omitted to determine effect of stopping the same, however routine training sessions continued. An evaluation of efficacy of training interventions was performed by comparing specimen rejection rates and patterns. Results: The overall rejection rate was 0.43%. Maximum rejections were seen from general wards in all phases. Hemolyzed and clotted samples comprised the vast majority (64.65 % in phase I, 68.72 % in second phase and 69.28% in the third phase) of the total rejections. There was significant reduction in rejections during the training phase, but the effect was seen dwindling when upon cessation of training. Conclusion: Sample rejection rates were significantly reduced upon targeted training. However, challenge lied in maintaining sustainability of reduced rejection rates. The findings mandate reviewing and redesigning processes of training periodically in sites of phlebotomy for optimizing quality assurance practices.

Keywords

• preanalytical phase
• quality indicators
• blood specimen
• quality
• risk management