Analysis of Preanalytical Errors in Clinical Biochemistry Laboratory of a Tertiary Care Hospital: A Retrospective Study

Abstract

Introduction: Pre-analytical phase of laboratory testing is the most susceptible phase, as errors in this phase leads to more than 50% of erroneous results and often breaches the trust of the stakeholders on the quality of the laboratory results. Many pre-analytical errors occur during the pre-analytical phase, encompassing sample collection, labelling and transportation- factors often beyond the laboratory’s direct control. Aim: To determine the type and frequency of pre-analytical errors leading to sample rejection in clinical biochemistry laboratory. Materials and Methods: Being a retrospective descriptive study, convenient sampling was used to analyse sample rejection due to pre-analytical errors in clinical biochemistry laboratory of a tertiary care teaching hospital- PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India for a period of six months from May 2023 to October 2023. All the cases/blood samples from Outpatient Department (OPD) and Inpatient Department (IPD), received and rejected during this period were included under study. The data collection and analysis was done over a period of five months using the sample rejection and resample description from Laboratory Information System (LIS). Using Statistical Package for the Social Sciences (SPSS) version 28.0, data were summarised using descriptive statistics such as numbers and percentages. Results: During the six months period out of the total of 667454 samples, 1505 (0.23%) samples were rejected due to pre-analytical errors. The majority of the samples which were rejected were from IPD than OPD. Among the pre-analytical errors, haemolysis accounted for 806 (53.6%), clotted samples 256 (17%), delta check 217 (14.4%), insufficient sample 129 (8.6%), contamination 74 (4.9%), identification error 14 (0.9%), sample without request form 3 (0.2%) while missing samples, billing error, inappropriate tube, delay in transport and wrong test selection accounted for <3 (0.1%). Conclusion: Haemolysis and clotted samples were the most common pre-analytical causes for sample rejection in the laboratory. The samples from IPD were rejected more often than OPD due to incorrect phlebotomy techniques. This accentuates the need for proper hands-on phlebotomy training sessions for novice nurses following their recruitment, as their competency will be instrumental in bringing down the errors in pre-analytical phase.

Keywords

• haemolysis
• patient care
• phlebotomy
• sample rejection