Quality-Improvement Measures as Effective Ways of Preventing Laboratory Errors

Abstract

Laboratory error is defined as any defect from ordering tests to reporting and interpretation of results. Laboratory errors have a reported frequency of 0.012-0.6% of all test results which in turn has huge impact on diagnosis and patient management as 60–70% of all diagnosis are made on the basis of laboratory tests. Total testing process in the laboratory is a cyclical process divided into three phases: preanalytical, analytical and postanalytical. First, pre-analytical phase in which requirement for a test is determined, the test is ordered and the patient is identified. It is followed by specimen collection and transport to the laboratory. The specimen is prepared and tested in the analytical phase. During the postanalytical phase, the results are reported to the individual who ordered the test and any action or intervention is undertaken. Initially, the policies and procedures developed by the laboratory were more concerned on analytical phase to reduce errors during laboratory testing and emphasis was in ensuring proper calibration and testing. The last few decades have seen a significant decrease in the rates of analytical errors in clinical laboratories. Currently, available evidences demonstrate that the pre- and postanalytical steps are more error prone. * IOM : Institute of Medicine NABL : National Accreditation Board for Testing and Calibration Laboratories CAP : College of American Pathologists JCI : The Joint Commission International QC : quality control COES : computerized order entry system CLSI : Clinical and Laboratory Standards Institute RFID : radio frequency identification OCR : optical character recognition TTP : thrombotic thrombocytopenic purpura EQAS : External Quality Assurance Program CLIA : Clinical Laboratory Improvement Amendments IQC : interlaboratory QC WHO : World Health Organization ATE : allowable total error POCT : point-of-care testing