Small Steps for a Big Change: Attention towards Preanalytical Error

Aims: The study aimed to evaluate the preanalytical errors in the Indoor patient department in tertiary care Hospital.To calculate the percentage of preanalyticalerrors in the Indoor patient department in our Hospital and to recommend standard operative interventions to improve quality of results. To test the effectiveness of attention by continuous educational action at reducing preanalytical errors and improvingpatient care.Study Design:An observational study.Place and Duration of Study: The work was done from July 2014 to July 2015at a tertiary care Hospital India.Methodology:We retrospectively reviewed the samples and test request forms received at Biochemistry laboratory for one month. The outcome measures were incomplete laboratory forms, mislabeling samples, inappropriate tests, wrong container, poor quality of samples and transportation problems. Two weeks of interventions in the form of continuous educational training and education regarding standard operative procedures were given to stakeholders to raise awareness towards the preanalytical phase. Two weeks later, data was monitored again for one month. Results:2330 and 2130 samples and request forms were monitored before-after intervention respectively from wards for one month each. Of the total chances of preanalytical errors, 22.17% were due to inappropriate tests, 81.5% were related to incomplete patient information, 97% lacking clinical information, 18.8% errors related to specimen information, 3.5% errors were of the deranged quality of the specimen, and in4.5% transportation problems were observed. Subsequently, these were reduced to 10%, 20%, 16.4%, 7.5%, 2.3%, 3.1% respectively. A significant difference in percentage change was observed in all the above errors after the one-month interventions for the reduction in preanalytical errors. Conclusion:The results of the present study revealed that taking small steps in the form of implementing standard operative procedures for collection, storage and transport facilities and continuous educational training of stakeholders would reduce big errors occurring due to human factors in preanalytical phase. We need good interdepartmental communication and cooperation to achieve good laboratory results and patient well being. This study improved the quality of test results and patient care

Development of a Novel Quality Improvement Indicator Based on the Hemolysis Index

Hemolysis frequently causes preanalytical errors in laboratory measurements. We aimed to develop a quality improvement indicator for evaluating the extent of inappropriate procedures causing hemolysis in clinical samples collected in medical care units. We defined the threshold value of the hemolysis index (H index) causing significant interference with analyte measurement and analyzed the H index values of clinical samples in relation to the threshold. The H index threshold value causing a 10% bias in the measurement of lactate dehydrogenase was found to be 25. The monthly mean H index and monthly frequency of samples with an H index >25 were significantly different among the types of ward (P=0.001, respectively), and significantly decreased after replacement of a laboratory centrifuge lacking temperature control (20.6±0.58 vs 23.30±1.08, P=0.01; 23.4±1.69% vs 32.6±1.78%, P=0.01). The monthly mean H index and the monthly frequency of samples with an H index above a threshold value may be useful quality improvement indicators for detection of inappropriate procedures in the acquisition and handling of blood samples in medical care units.

Sample rejection as a quality indicator for continual improvement of laboratory services, tertiary care hospital.

Background: Quality in the health care institutions is multifaceted & multidimensional with its core element as the customer’s satisfaction. Improvement in the health care services is a long drawn relentless process which can be achieved by implementing a carefully planned Quality Management System. Laboratory services B.J. Medical College & Civil Hospital Ahmedabad, has set its Quality indicators and is monitoring it as a part of continual improvement. One of the Quality indicators is Sample rejection. The laboratory aims to reduce the sample rejections by complying with the standards & recommended guidelines. Methods: This is to monitor & analyze the Sample Rejections as a Quality Indicator for Continual improvement of the Microbiology Department. Primary data collection done before training & secondary data collection done after the training of nursing staff & Resident Doctors. Results: The sample rejection rate of the Microbiology Laboratory in the month of July 2010 was 0.31%. After the training of the nursing staff as well as resident doctors regarding proper collection & transport of samples based on scientific principles, a decreasing trend in the sample rejection rate is observed. i. e. from .31% to 0.11 % in the 13 months duration of study.Conclusion: The implementation of a systematic error-tracking system i.e. monitoring the sample rejections, analysing its trend, taking preventive & corrective actions to reduce the sample rejection rate in daily practice definitely improves the quality of the laboratory results and is a quality indicator for continual improvement of the laboratory.