Medical Errors: Pre-Analytical Issue in Patient Safety

Open access

Medical Errors: Pre-Analytical Issue in Patient Safety

The last few decades have seen a significant decrease in the rates of analytical errors in clinical laboratories, while a growing body of evidence demonstrates that the pre- and post-analytical steps of the total testing process (TTP) are more error-prone than the analytical phase. In particular, most errors are identified in pre-pre-analytic steps outside the walls of the laboratory, and beyond its control. However, in a patient-centred approach to the delivery of health care services, there is the need to investigate, in the total testing process, any possible defect that may have a negative impact on the patient, irrespective of which step is involved and whether the error depends on a laboratory professional (e.g. calibration or testing error) or a non-laboratory operator (e.g. inappropriate test request, error in patient identification and/or blood collection). In the pre-analytic phase, the frequency of patient/specimens misidentification and the presence of possible causes of specimen rejection (haemolysis, clotting, insufficient volume, etc.) represent a valuable risk for patient safety. Preventing errors in the pre-analytical steps requires both technological developments (wristband, barcodes, pre-analytical workstations) and closer relationships with the clinical world to achieve an effective team-working cooperation. The most important lesson we have learned, therefore, is that laboratory errors and injuries to patients can be prevented by redesigning systems that render it difficult for all caregivers and in all steps of the total testing process to make mistakes.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Vincent C. Patient Safety 2nd ed. Chichester UK John Wiley & Sons 2010.

  • Kohn LT Corrigan JM Donaldson MS. To err is human: building a safer health system. Washington D. C.: National Academies Press 1999.

  • Leape LL. Errors in medicine. Clin Chim Acta 2009; 404: 2-5.

  • Plebani M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem 2010; 47: 101-10.

  • Plebani M Carraro P. Mistakes in a stat laboratory: types and frequency. Clin Chem 1997; 43: 1348-51.

  • Carraro P Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Clin Chem 2007; 53: 1338-42.

  • Astion ML Shojana KG Hamil TR Kim S Ng VL. Classifying laboratory incidents reports to identify problems that jeopardize patient safety. Am J Clin Pathol 2003; 120: 18-26.

  • Howanitz PJ. Errors in laboratory medicine: practical lessons to improve patient safety. Arch Pathol Lab Med 2005; 129: 1252-61.

  • Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med 2006; 44: 750-9.

  • Plebani M. Errors in laboratory medicine and patient safety: the road ahead. Clin Chem Lab Med 2007; 45: 700-7.

  • Plebani M. Exploring the iceberg of errors in laboratory medicine. Clin Chim Acta 2009; 404: 16-23.

  • Lundberg GD. Acting on significant laboratory results. JAMA 1981; 245: 1762-3.

  • Lundberg GD. The need for an outcome research agenda for clinical laboratory testing. JAMA 1998; 280: 565-6.

  • Graber ML. The physician and the laboratory. Partners in reducing diagnostic error related to laboratory testing. Am J Clin Pathol 2005; 124 (Suppl 1): S1-S4.

  • Stroobants AK Goldschmidt HM Plebani M. Error budget calculations in laboratory medicine: linking the concepts of biological variation and allowable medical errors. Clin Chim Acta 2003; 333: 169-76.

  • Hickner J Graham DG Elder NC Brandt E Emsermann CB Dovey S Phillips R. Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of Family Physicians National Research Network. Qual Saf Health Care 2008; 17: 194-200.

  • Gandhi TK Kachalia A Thomas EJ Puopolo AL Yoon C Brennan TA Studdert DM. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 2006; 145: 488-96.

  • Wahls TL Cram PM. The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC Fam Pract 2007; 8: 32-42.

  • Kachalia A Gandhi TK Pupolo AL Yoon C Thomas EJ Griffey R Brennan TA Studdert DM. Missed and delayed diagnoses in the Emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med 2007; 49: 196-205.

  • Graber ML Franklin N Gordon R. Diagnostic error in internal medicine. Arch Intern Med 2005 165: 1493-9.

  • Bonini P Plebani M Ceriotti F Rubboli F. Errors in laboratory medicine. Clin Chem 2002; 48: 691-8.

  • ISO/TS 22367: 2008. Medical laboratories-reduction of error through risk management and continual improvement.

  • Lippi G Blanckaert N Bonini P Green S Kitchen S Palicka V Vassault AJ Mattiuzzi C Plebani M. Causes consequences detection and prevention of identification errors in laboratory diagnostics. Clin Chem Lab Med 2009;47: 143-53.

  • Da Rin G. Pre-analytical workstations: a tool for reducing laboratory errors. Clin Chim Acta 2009; 404: 68-74.

  • Da Rin G. Pre-analytical workstations as a tool for reducing laboratory errors. Journal of Medical Biochemistry 2010; 29: 315-24.

  • Lippi G Guidi GC Mattiuzzi C Plebani M. Pre-analytical variability: the dark side of the moon in laboratory testing. Clin Chem Lab Med 2006: 44: 358-65.

  • Lippi G Guidi GC. Risk management in the pre-analytical phase of laboratory testing. Clin Chem Lab Med 2007; 45: 720-7.

  • Lippi G Banfi G Buttarello M Ceriotti F Daves M Dolci A Caputo M Giavarina D Montagnana M Miconi V Milanesi B Mosca A Morandini M Salvagno GL. Recommendations for detection and management of unsuitable samples in clinical laboratories. Clin Chem Lab Med 2007; 45: 728-36.

  • Lippi G Blanckaert N Bonini P Green S Kitchen S Palicka V Vassault AJ Plebani M. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clin Chem Lab Med 2008; 46: 764-72.

  • Lippi G Salvagno GL Favaloro EJ Guidi GC. Survey on the prevalence of hemolytic specimens in an academic hospital according to collection facility: opportunities for quality improvement. Clin Chem Lab Med 2009; 47: 616-8.

  • Lippi G Salvagno GL Montagnana M Brocco G Guidi GC. Influence of hemolysis on routine clinical chemistry testing. Clin Chem Lab Med 2006; 44: 311-16.

  • Plebani M Lippi G. Hemolysis index: quality indicator or criterion for sample rejection? Clin Chem Lab Med 2009; 47 (8): 899-902.

  • Lippi G Luca Salvagno G Blanckaert N Giavarina D Green S Kitchen S Palicka V Vassault AJ Plebani M. Multicenter evaluation of the hemolysis index in automated clinical chemistry systems. Clin Chem Lab Med 2009; 47(8): 934-9.

  • Holman JW Mifflin TE Felder RA Demers LM. Evaluation of an automatic pre-analytical robotic work-station at two academic health centers. Clin Chem 2002; 48: 540-8.

  • Sciacovelli L Plebani M. The IFCC working group on laboratory errors and patient safety. Clin Chim Acta 2009; 404: 79-85.

  • ISO 15189: 2007. Medical laboratories - Particular requirements for quality and competence.

  • Chiozza ML Ponzetti C. FMEA: a model for reducing medical errors. Clin Chim Acta 2009; 404: 75-8.

  • Plebani M Ceriotti F Messeri G Ottomano C Pansini N Bonini P. Laboratory network of excellence: enhancing patient safety and services effectiveness. Clin Chem Lab Med 2006; 44: 150-60.

  • Signori C Ceriotti F Sanna A Plebani M Messeri G Ottomano C Di Serio F Bonini P. Process and risk analysis to reduce errors in clinical laboratories. Clin Chem Lab Med 2007; 45: 742-8.

Search
Journal information
Impact Factor

IMPACT FACTOR 2018: 2.000
5-year IMPACT FACTOR: 1.075

CiteScore 2018: 1.47

SCImago Journal Rank (SJR) 2018: 0.523
Source Normalized Impact per Paper (SNIP) 2018: 0.581

Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 591 238 7
PDF Downloads 293 131 4