scholarly journals Quality Indicators of the Pre-Analytical Phase

2012 ◽  
Vol 31 (3) ◽  
pp. 174-183 ◽  
Author(s):  
Nada Majkić-Singh ◽  
Zorica Šumarac
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Indicators ◽  
Task Force ◽  
Improve Patient Safety ◽  
Laboratory Data ◽  
Sample Collection ◽  
Laboratory Errors ◽  
Analytical Phase ◽  
Total Testing Process

Quality Indicators of the Pre-Analytical PhaseQuality indicatorsare tools that allow the quantification of quality in each of the segments of health care in comparison with selected criteria. They can be defined as an objective measure used to assess the critical health care segments such as, for instance, patient safety, effectiveness, impartiality, timeliness, efficiency, etc. In laboratory medicine it is possible to develop quality indicators or the measure of feasibility for any stage of the total testing process. The total process or cycle of investigation has traditionally been separated into three phases, the pre-analytical, analytical and post-analytical phase. Some authors also include a »pre-pre« and a »post-post« analytical phase, in a manner that allows to separate them from the activities of sample collection and transportation (pre-analytical phase) and reporting (post-analytical phase). In the year 2008 the IFCC formed within its Education and Management Division (EMD) a task force calledLaboratory Errors and Patient Safety (WG-LEPS)with the aim of promoting the investigation of errors in laboratory data, collecting data and developing a strategy to improve patient safety. This task force came up with the Model of Quality Indicators (MQI) for the total testing process (TTP) including the pre-, intra- and post-analytical phases of work. The pre-analytical phase includes a set of procedures that are difficult to define because they take place at different locations and at different times. Errors that occur at this stage often become obvious later in the analytical and post-analytical phases. For these reasons the identification of quality indicators is necessary in order to avoid potential errors in all the steps of the pre-analytical phase.

Brazilian laboratory indicators benchmarking program: three-year experience on pre-analytical quality indicators

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Wilson Shcolnik ◽  
Fernando Berlitz ◽  
Cesar Alex de O. Galoro ◽  
Vinicius Biasoli ◽  
Rafael Lopes ◽  
...  
Keyword(s):  
Patient Safety ◽  
Best Practices ◽  
Quality Indicators ◽  
Monitoring Program ◽  
Laboratory Medicine ◽  
Comparative Performance ◽  
Pathology Laboratory ◽  
Pareto Chart ◽  
Laboratory Errors ◽  
Analytical Phase

AbstractObjectivesIn the laboratory medicine segment, benchmarking is the process in which institutions seek to compare with the macro environment (performance comparison and best practices with different laboratories) and improve their results based on quality indicators. The literature has highlighted the vulnerability of the pre-analytical phase in terms of risks and failures and the use of interlaboratory comparison as an opportunity to define a strategic performance benchmark aligned with the laboratory medicine sector, which has been a promising strategy to ensure continuous improvement, identifying within the pre-analytical process the critical activities to guarantee patient safety. In this context, this paper aims to present the three-year experience (2016–2018) of the Benchmarking Program and Laboratory Indicators – in Portuguese, Programa de Benchmarking e Indicadores Laboratoriais (PBIL) – with emphasis on pre-analytical indicators and their comparison against literature references and other programs of benchmarking in the area of laboratory medicine. PBIL is organized by the Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) in conjunction with Controllab and coordinated by a Brazilian group with representatives from different countries.MethodsThe data presented in this paper involving the performance results of 180 laboratories with active participation. Results are presented in percentage (%, boxplot graphical in quartiles) and Sigma metric, recognized as the metric that best indicates the magnitude of failures in a process. The Pareto Chart was used to facilitate ordering and to identify the main errors in the pre-analytical phase. The Radar Chart was made available in this work for the purpose of comparing the results obtained in Sigma by the PBIL and IFCC Working Group Laboratory Errors and Patient Safety (WG LEPS).ResultsIn the study period, just over 80% of the pre-analytical failures are related to Blood culture contamination (hospital-based and non-hospital-based laboratories), Recollect and Non-registered exams, with failure rates of 2.70, 1.05 and 0.63%, respectively. The performance of the PBIL program participants was in line with the literature references, and allowed to identify benchmarks in the laboratory medicine market, target of PBIL, with best practices were observed for some indicators.ConclusionsThe results of the program demonstrate the importance of an ongoing program comparative performance-monitoring program for setting more robust goals and consequently reducing laboratory process failures. Even with these promising premises and results, the contextualized analysis of the program indicators, point to a still significant number of failures in our market, with possibilities for improvement in order aiming to ensure more robust and effective processes.

A pilot study for establishing quality indicators in molecular diagnostics according to the IFCC WG-LEPS initiative: preliminary findings in China

2019 ◽  
Vol 57 (6) ◽  
pp. 822-831 ◽  
Author(s):  
Rui Zhou ◽  
Yali Wei ◽  
Laura Sciacovelli ◽  
Mario Plebani ◽  
Qingtao Wang
Keyword(s):  
Patient Safety ◽  
Quality Indicators ◽  
Molecular Diagnostics ◽  
Clinical Chemistry ◽  
Priority Level ◽  
Laboratory Errors ◽  
Promising Tool ◽  
Laboratory Services ◽  
Total Testing Process

Abstract Background Quality indicators (QIs) are crucial tools in measuring the quality of laboratory services. Based on the general QIs of the Working Group “Laboratory Errors and Patient Safety (WG-LEPS)” of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), specific QIs have been established in order to monitor and improve the quality of molecular diagnostics, and to assess the detection level of associated disease. Methods A survey was conducted on 46 independent commercial laboratories in China, investigated using questionnaires and on-site inspections. Specific QIs established were mainly based on the specific laboratory work-flow for molecular diagnoses. The specific QI results from three volunteer laboratories were collected and used to validate their effectiveness. Results Of the 46 laboratories participating in the study, 44 (95.7%), conducted molecular diagnostics. Of 13 specific established QIs, six were priority level 1, and seven, priority level 3. At pre-evaluation of data from the three volunteering laboratories, it was found that the newly classified specific QIs had outstanding advantages in error identification and risk reduction. Conclusions Novel specific QIs, a promising tool for monitoring and improving upon the total testing process in molecular diagnostics, can effectively contribute to ensuring patient safety.

scholarly journals Blood sampling guidelines with focus on patient safety and identification – a review

Diagnosis ◽  
2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Michael Cornes ◽  
Mercedes Ibarz ◽  
Helene Ivanov ◽  
Kjell Grankvist
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Venous Blood ◽  
Blood Collection ◽  
Patient Identification ◽  
Open Questions ◽  
Working Groups ◽  
Analytical Phase ◽  
Total Testing Process ◽  
Improve Patient

AbstractIt has been well documented over recent years that the pre-analytical phase is a leading contributor to errors in the total testing process (TTP). There has however been great progress made in recent years due to the exponential growth of working groups specialising in the field. Patient safety is clearly at the forefront of any healthcare system and any reduction in errors at any stage will improve patient safety. Venous blood collection is a key step in the TTP, and here we review the key errors that occur in venous phlebotomy process and summarise the evidence around their significance to patient safety. Recent studies have identified that patient identification and tube labelling are the steps that carry the highest risk with regard to patient safety. Other studies have shown that in 16.1% of cases, patient identification is incorrectly performed and that 56% of patient identification errors are due to poor labelling practice. We recommend that patient identification must be done using open questions and ideally three separate pieces of information. Labelling of the tube or linking the identity of the patient to the tube label electronically must be done in the presence of the patient whether it is before or after sampling. Combined this will minimise any chance of patient misidentification.

scholarly journals Evaluation of pre-analytical phase performance of emergency laboratory by harmonized quality indicators and six sigma

2021 ◽  
Vol 9 (2) ◽  
pp. 64-70
Author(s):  
Arumalla VK ◽  
Chelliah S ◽  
Madhubala V
Keyword(s):  
Patient Safety ◽  
Quality Indicators ◽  
Six Sigma ◽  
Working Group ◽  
Clinical Chemistry ◽  
International Federation ◽  
Laboratory Errors ◽  
The World ◽  
Analytical Phase ◽  
Analytical Errors

Background: Pre-analytical errors account for up to 70% of all the errors made in laboratory diagnostics which are mostly not directly under laboratory control. Laboratories across the world have been using different Quality indicators (QIs) for identifying and quantification of pre-analytical errors. Objective of the present study is to identify the different pre-analytical errors with their frequency and to assess the pre-analytical phase performance of emergency laboratory by using harmonized Quality Indicators and six sigma metrics. Methods and material: A prospective observational study was conducted from January 2019 to December 2019 to monitor the inappropriateness of samples and test request forms. We have quantified the performance of pre-analytical phase of our emergency laboratory based on the harmonized QIs proposed by The International Federation of Clinical Chemistry Working Group on Laboratory Errors and Patient Safety (IFCC- WGLEPS) and six sigma metrics. Results: Emergency laboratory received a total of 55431 samples during Jan- 2019 to Dec- 2019. Number of pre-analytical errors were 1089 which accounted for 1.96% of total samples received. Haemolysed samples, clotted samples and samples with insufficient volume were contributed to 37%, 26% and 15% of the total pre-analytical errors respectively. Conclusions: Pre-analytical phase performance of our emergency laboratory complies with the quality specifications laid by the International Federation of Clinical Chemistry Working Group on Laboratory Errors and Patient Safety (IFCC-WGLEPS). Implementation of harmonised QIs assures the comparability of laboratory findings with different laboratories across the world.

Laboratory errors and patient safety

2015 ◽  
Vol 28 (1) ◽  
pp. 2-10 ◽  
Author(s):  
Dawlat A. Miligy
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Laboratory Data ◽  
Laboratory Work ◽  
Significant Implication ◽  
Content Type ◽  
Testing Procedures ◽  
Laboratory Errors ◽  
Patient Health ◽  
Test Errors

Purpose – Laboratory data are extensively used in medical practice; consequently, laboratory errors have a tremendous impact on patient safety. Therefore, programs designed to identify and reduce laboratory errors, as well as, setting specific strategies are required to minimize these errors and improve patient safety. The purpose of this paper is to identify part of the commonly encountered laboratory errors throughout our practice in laboratory work, their hazards on patient health care and some measures and recommendations to minimize or to eliminate these errors. Design/methodology/approach – Recording the encountered laboratory errors during May 2008 and their statistical evaluation (using simple percent distribution) have been done in the department of laboratory of one of the private hospitals in Egypt. Errors have been classified according to the laboratory phases and according to their implication on patient health. Findings – Data obtained out of 1,600 testing procedure revealed that the total number of encountered errors is 14 tests (0.87 percent of total testing procedures). Most of the encountered errors lay in the pre- and post-analytic phases of testing cycle (representing 35.7 and 50 percent, respectively, of total errors). While the number of test errors encountered in the analytic phase represented only 14.3 percent of total errors. About 85.7 percent of total errors were of non-significant implication on patients health being detected before test reports have been submitted to the patients. On the other hand, the number of test errors that have been already submitted to patients and reach the physician represented 14.3 percent of total errors. Only 7.1 percent of the errors could have an impact on patient diagnosis. Practical implications – The findings of this study were concomitant with those published from the USA and other countries. This proves that laboratory problems are universal and need general standardization and bench marking measures. Originality/value – Original being the first data published from Arabic countries that evaluated the encountered laboratory errors and launch the great need for universal standardization and bench marking measures to control the laboratory work.

Top four types of sentinel events in Saudi Arabia during the period 2016–19

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Nasser Altalhi ◽  
Haifa Alnaimi ◽  
Mafaten Chaouali ◽  
Falaa Alahmari ◽  
Noor Alabdulkareem ◽  
...  
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Patient Safety ◽  
Reporting System ◽  
Improve Patient Safety ◽  
Health Care Facilities ◽  
Common Root ◽  
Private Hospitals ◽  
Care Facilities ◽  
Sentinel Events

Abstract Background This study discusses the summary, investigation and root causes of the top four sentinel events (SEs) in Saudi Arabia (SA) that occurred between January 2016 and December 2019, as reported by the Ministry of Health (MOH) and private hospitals through the MOH SE reporting system (SERS). It is intended for use by legislators, health-care facilities and the public to shed light on areas that still need improvement to preserve patient safety. Objectives The purpose of this study is to review the most common SEs reported by the MOH and private hospitals between the years 2016 and 2019 to assess the patterns and identify risk areas and the common root causes of these events in order to promote country-wide learning and support services that can improve patient safety. Methods In this retrospective descriptive study, the data were retrieved from the SERS, which routinely collects records from both MOH and private hospitals in SA. SEs were analyzed by type of event, location, time, patient demographics, outcome and root causes. Results There were 727 SEs during this period, 38.4% of which were under the category of unexpected patient death, 19.4% under maternal death, 11.7% under unexpected loss of limb or function and 9.9% under retained instruments or sponge. Common root causes were related to policies and procedures, guidelines, miscommunication between health-care facilities, shortage of staff and lack of competencies. Conclusion Given these results, efforts should focus on improving the care of deteriorating patients in general wards, ICU (Intensive Care Units) admission/discharge criteria and maternal, child and surgical safety. The results also highlighted the problem of underreporting of SEs, which needs to be addressed and improved. Linking data sources such as claims and patient complaints databases and electronic medical records to the national reporting system must also be considered to ensure an optimal estimation of the number of events.

Performance criteria and quality indicators for the pre-analytical phase

2015 ◽  
Vol 53 (6) ◽  
Author(s):  
Mario Plebani ◽  
Laura Sciacovelli ◽  
Ada Aita ◽  
Michela Pelloso ◽  
Maria Laura Chiozza
Keyword(s):  
Quality Indicators ◽  
Performance Criteria ◽  
Analytical Quality ◽  
Performance Targets ◽  
Laboratory Services ◽  
Quality Specifications ◽  
Analytical Phase ◽  
Total Testing Process ◽  
The Individual

AbstractThe definition, implementation and monitoring of valuable analytical quality specifications have played a fundamental role in improving the quality of laboratory services and reducing the rates of analytical errors. However, a body of evidence has been accumulated on the relevance of the extra-analytical phases, namely the pre-analytical steps, their vulnerability and impact on the overall quality of the laboratory information. The identification and establishment of valueable quality indicators (QIs) represents a promising strategy for collecting data on quality in the total testing process (TTP) and, particularly, for detecting any mistakes made in the individual steps of the pre-analytical phase, thus providing useful information for quality improvement projects. The consensus achieved on the developed list of harmonized QIs is a premise for the further step: the identification of achievable and realistic performance targets based on the knowledge of the state-of-the-art. Data collected by several clinical laboratories worldwide allow the classification of performances for available QIs into three levels: optimum, desirable and minimum, in agreement with the widely accepted proposal for analytical quality specifications.

Pre-analytical quality indicators in laboratory medicine: Performance of laboratories participating in the IFCC working group “Laboratory Errors and Patient Safety” project

2019 ◽  
Vol 497 ◽  
pp. 35-40 ◽  
Author(s):  
Laura Sciacovelli ◽  
Giuseppe Lippi ◽  
Zorica Sumarac ◽  
Isabel Garcia del Pino Castro ◽  
Agnes Ivanov ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Indicators ◽  
Working Group ◽  
Laboratory Medicine ◽  
Analytical Quality ◽  
Laboratory Errors

Leveraging Information Technology Towards Enhancing Patient Care and a Culture of Safety in the U.S.

2003 ◽  
Vol 42 (05) ◽  
pp. 503-508 ◽  
Author(s):  
D. E. Garets ◽  
T. J. Handler ◽  
M. J. Ball
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Patient Care ◽  
Information Technologies ◽  
Improve Patient Safety ◽  
Medical Knowledge ◽  
Mortality And Morbidity ◽  
Culture Of Safety ◽  
Enabling Technologies ◽  
Enhance Patient Care

Summary Objectives: To heighten awareness about the critical issues currently affecting patient care and to propose solutions based on leveraging information technologies to enhance patient care and influence a culture of patient safety. Methods: Presentation and discussion of the issues affecting health care today, such as medical and medication-related errors and analysis of their root causes; proliferation of medical knowledge and medical technologies; initiatives to improve patient safety; steps necessary to develop a culture of safety; introduction of relevant enabling technologies; and evidence of results. Results and Conclusion: Medical errors affect not only mortality and morbidity, but they also create secondary costs leading to dissatisfaction by both provider and patient. Health care has been slow to acknowledge the benefits of enabling technologies to affect the quality of care. Evaluation of recent applications, such as the computerized patient record, physician order entry, and computerized alerting systems show tremendous potential to enhance patient care and influence the development of a culture focused on safety. They will also bring about changes in other areas, such as workflow and the creation of new partnerships among providers, patients, and payers.

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