scholarly journals Determination of errors that compromise the quality of laboratory service in a tertiary hospital

2017 ◽  
Vol 8 (1) ◽  
pp. 64-70
Author(s):  
Kenneth Kipruto Kimengech ◽  
Stanley Kinge Waithaka ◽  
Jackson Onyuka ◽  
Christine Sekadde Kigondu
Keyword(s):  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Common Knowledge ◽  
Tertiary Hospital ◽  
Chemistry Laboratory ◽  
Laboratory Service ◽  
Laboratory Errors ◽  
Analytical Errors

Background: Clinical Laboratory testing is a highly complex process that entails numerous procedures. Although it has been known that laboratory testing services are safe, it is increasingly becoming a common knowledge that they are not that safe. Studies have indicated that there are a number of errors that occur due to laboratory testing processes. These errors may not be realized easily during the testing process, but they make significant impact on the results given.Aims and Objective: To determine the levels of pre-analytical, analytical, and post analytical errors found in the analysis of Clinical Laboratory specimen at Kenyatta National Hospital.Materials and Methods: A prospective and descriptive study was carried out at Clinical Chemistry Laboratory, Department of Laboratory Medicine, Kenyatta National Hospital. A total of 346 request forms, specimens/samples and dispatched results were scrutinized and errors documented as per the different variables in the different phases, over a period of three months and the findings were analyzed.Results: Results of the study showed that Preanalytical errors were most common with a frequency of 148(42.8%), followed by analytical errors 114 (32.9%) and post analytical errors 84 (24.3%), respectively.Conclusions: The study concludes that pre-analytical, analytical, and post analytical errors are errors that compromise the quality of laboratory service delivery, which impacts on the patient management and diagnosis. Clinical laboratory errors can be minimized if due diligence and professionalism is adhered in the laboratory.Asian Journal of Medical Sciences Vol.8(1) 2017 64-70

scholarly journals Laboratory Errors: Types and Frequency in a Tertiary Hospital in Bangladesh

2016 ◽  
Vol 33 (1) ◽  
pp. 3-6
Author(s):  
Nasreen Chowdhury ◽  
Md Ibrahim ◽  
Md Aminul Haque Khan
Keyword(s):  
Quality Control ◽  
Clinical Chemistry ◽  
Control Program ◽  
Tertiary Hospital ◽  
Blood Collection ◽  
Quality Control Program ◽  
Laboratory Errors ◽  
Clinical Laboratories ◽  
Primary Sample ◽  
Analytical Errors

Introduction: In our country, very few of clinical laboratories are running proper quality control program and to the best of our knowledge the preanalytical, analytical, and postanalytical rates of laboratory errors have not been studied extensively. In this study we evaluated the preanalytical, analytical, and postanalytical components of laboratory errors in 3,200 consecutive specimens of a clinical chemistry laboratory in a tertiary hospital for measurement of different analyte concentrations in plasma or serum. Materials and methods: This study was conducted during the period from June 2009 to July 2010 on 3,200 specimens. Analytical errors were detected by repeat analysis of primary sample and by checking quality control. Results: The numbers of preanalytical, analytical and postanalytical errors were 23, 14 and 76 respectively among 32000 tests that we have done on 3,200 specimens (average 10 tests per specimen). Moreover, the causes of errors were analyzed and it was found that preanalytical errors were mostly due to specimen drawn distal to IV infusion, specimen for potassium first drawn into GREY tube (containing sodium fluoride and K EDTA) and then transferred into GREEN tube, long tourniquet time and underfilling of blood collection tube. The analytical errors were due to random and systemic errors and postanalytical errors were due to transcription errors. Conclusion: Results of our study suggest that errors mostly occur in the postanalytical part of testing and they are due to transcription errors. To reduce the laboratory errors we suggest introduction of Laboratory Information System (LIS) of the clinical laboratories connected with Hospital Management System along with stringent quality control program in preanalytical, analytical and postanalytical stages.J Bangladesh Coll Phys Surg 2015; 33(1): 3-6

The Cost of Implementation of the Clinical Laboratory Improvement Amendments of 1988—The Example of Pediatric Office-Based Cholesterol Screening

PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 230-234
Author(s):  
Andrew M. Tershakovec ◽  
S. Diane Brannon ◽  
Michael J. Bennett ◽  
Barbara M. Shannon
Keyword(s):  
Proficiency Testing ◽  
Laboratory Testing ◽  
Clinical Laboratory ◽  
High Volume ◽  
Chemistry Laboratory ◽  
Screening Process ◽  
Cholesterol Screening ◽  
Low Volume ◽  
The Cost ◽  
Clinical Laboratory Improvement Amendments

Objective. To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example. Methods. Four-to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs. Results. In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing. Conclusions. Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.

Comparison of results for 13 clinical laboratory determinations with three automated analytical systems.

1976 ◽  
Vol 22 (3) ◽  
pp. 346-349 ◽  
Author(s):  
E J Sampson ◽  
D D Derck ◽  
L M Demers
Keyword(s):  
Normal Control ◽  
Continuous Flow ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Upper Limits ◽  
Control Serum ◽  
Flow Systems ◽  
Clinical Chemistry Laboratory ◽  
Better Than

Abstract We evaluated the Abbott Bichromatic Analyzer-100 (ABA-100) for use in the routine clinical chemistry laboratory by examining 13 different determinations that can be performed on the instrument. Results with the Du Pont "aca" and Technicon continuous-flow systems were compared to the ABA-100 in terms of upper limits of linearity, inter-run coefficient of variation, and results for samples from patients. The upper limits of linearity for the methods on the ABA-100 exceeded all of those for the continuous-flow systems, except for urea nitrogen. Precision of the ABA-100 was as good as or better than that of the aca for all determinations, except for glucose in a normal control serum and creatine kinase and creatinine in an above-normal control serum.

Understanding and managing interferences in clinical laboratory assays: the role of laboratory professionals

2020 ◽  
Vol 58 (3) ◽  
pp. 350-356 ◽  
Author(s):  
Martina Zaninotto ◽  
Mario Plebani
Keyword(s):  
Patient Safety ◽  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Careful Evaluation ◽  
The Matrix ◽  
Analytical Phase

AbstractThe recently raised concerns regarding biotin interference in immunoassays have increased the awareness of laboratory professionals and clinicians of the evidence that the analytical phase is still vulnerable to errors, particularly as analytical interferences may lead to erroneous results and risks for patient safety. The issue of interference in laboratory testing, which is not new, continues to be a challenge deserving the concern and interest of laboratory professionals and clinicians. Analytical interferences should be subdivided into two types on the basis of the possibility of their detection before the analytical process. The first (type 1) is represented by lipemia, hemolysis and icterus, and the second (type 2), by unusual constituents that are not undetectable before analysis, and may affect the matrix of serum/plasma of individual subjects. Type 2 cannot be identified with current techniques when performing the pre-analytical phase. Therefore, in addition to a more careful evaluation and validation of the method to be used in clinical practice, the awareness of laboratory professionals should be raised as to the importance of evaluating the quality of biological samples before analysis and to adopt algorithms and approaches in the attempt to reduce problems related to erroneous results due to specific or non-specific interferences.

An evaluation of the detection capacity of a computer-assisted real-time delta check system.

1979 ◽  
Vol 25 (6) ◽  
pp. 870-872 ◽  
Author(s):  
P P Sher
Keyword(s):  
Real Time ◽  
Clinical Condition ◽  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Computer Assisted ◽  
Test Results ◽  
Laboratory Staff ◽  
Laboratory Errors ◽  
Clinical Chemistry Laboratory ◽  
Check System

Abstract We developed of computer programs to evaluate the clinical reliability of test results by comparing each new result with previous results for the same patient, and to signal discrepancies in real time. These "delta check" discrepancies are noted, and they must be reviewed by the laboratory staff before results can appear on a patient's record. During a month, I reviewed 1403 such delta check messages and detected 55 (3.9%) that could not be explained on the basis of the patient's clinical condition. Of these, 23 represented true laboratory errors, which were corrected. The recognition of discrepancies before they appear on patients' reports has facilitated the operation of the clinical chemistry laboratory. Mislabeled and otherwise mishandled specimens are discovered before erroneous results appear on a patient's record.

Automatic Discrete Sample Processing: Automation in a Clinical Chemistry Laboratory Based on Discrete Sample Handling and Computerized Data Processing

1969 ◽  
Vol 15 (7) ◽  
pp. 600-610 ◽  
Author(s):  
George Westlake ◽  
Donald K McKay ◽  
Philip Surh ◽  
David Seligson
Keyword(s):  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Present Report ◽  
General Purpose ◽  
Electrical Signal ◽  
Chemistry Laboratory ◽  
Sample Handling ◽  
Discrete Sample ◽  
Operational Characteristics ◽  
Clinical Chemistry Laboratory

Abstract It is our belief that a general-purpose digital computer that receives and processes the electrical signal from an analytic instrument to its final step, and then processes the latter to produce a patient report, is an essential tool of the clinical laboratory. The present report concerns the development of a discrete-sample-handling analytic instrument that was designed to interface with a computer. A description is given of the entire system that includes the interface, multiplexing, sample identification, and operational characteristics of the instrument. Some advantages of discrete sample handling in analytic chemistry are accuracy, speed, ease of adaptation to computers, use of small amounts of sample, stepwise analysis of analytic method, and ease of trouble-shooting.

Extra-analytical quality indicators – where to now?

2017 ◽  
Vol 0 (0) ◽  
Author(s):  
Ada Aita ◽  
Laura Sciacovelli ◽  
Mario Plebani
Keyword(s):  
Quality Indicators ◽  
Clinical Laboratory ◽  
State Of The Art ◽  
Clinical Chemistry ◽  
Large Body ◽  
The State ◽  
Laboratory Errors ◽  
Management Procedure ◽  
Performance Specifications ◽  
Improvement Programs

AbstractA large body of evidence collected in recent years demonstrates the vulnerability of the extra-analytical phases of the total testing process (TTP) and the need to promote quality and harmonization in each and every step of the testing cycle. Quality indicators (QIs), which play a key role in documenting and improving quality in TTP, are essential requirements for clinical laboratory accreditation. In the last few years, wide consensus has been achieved on the need to adopt universal QIs and common terminology and to harmonize the management procedure concerning their use by adopting a common metric and reporting system. This, in turn, has led to the definition of performance specifications for extra-analytical phases based on the state of the art as indicated by data collected on QIs, particularly by clinical laboratories attending the Model of Quality Indicators program launched by the Working Group “Laboratory Errors and Patient Safety” of the International Federation of Clinical Chemistry and Laboratory Medicine. Harmonization plays a fundamental role defining not only the list of QIs to use but also performance specifications based on the state of the art, thus providing a valuable interlaboratory benchmark and tools for continuous improvement programs.

scholarly journals MODULARANALYTICS: A New Approach to Automation in the Clinical Laboratory

2005 ◽  
Vol 2005 (1) ◽  
pp. 8-25 ◽  
Author(s):  
Gary L. Horowitz ◽  
Zahur Zaman ◽  
Norbert J. C. Blanckaert ◽  
Daniel W. Chan ◽  
Jeffrey A. Dubois ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Control Unit ◽  
Turnaround Time ◽  
Chemistry Laboratory ◽  
New Approach ◽  
Typical Sample ◽  
Clinical Chemistry Laboratory ◽  
Carry Over ◽  
Roche Diagnostics

MODULARANALYTICS(Roche Diagnostics) (MODULARANALYTICS, Elecsys and Cobas Integra are trademarks of a member of the Roche Group) represents a new approach to automation for the clinical chemistry laboratory. It consists of a control unit, a core unit with a bidirectional multitrack rack transportation system, and three distinct kinds of analytical modules: an ISE module, a P800 module (44 photometric tests, throughput of up to 800 tests/h), and a D2400 module (16 photometric tests, throughput up to 2400 tests/h). MODULARANALYTICSallows customised configurations for various laboratory workloads. The performance and practicability of MODULARANALYTICSwere evaluated in an international multicentre study at 16 sites. Studies included precision, accuracy, analytical range, carry-over, and workflow assessment. More than 700 000 results were obtained during the course of the study. Median between-day CVs were typically less than 3% for clinical chemistries and less than 6% for homogeneous immunoassays. Median recoveries for nearly all standardised reference materials were within 5% of assigned values. Method comparisons versus current existing routine instrumentation were clinically acceptable in all cases. During the workflow studies, the work from three to four single workstations was transferred to MODULARANALYTICS, which offered over 100 possible methods, with reduction in sample splitting, handling errors, and turnaround time. Typical sample processing time on MODULARANALYTICSwas less than 30 minutes, an improvement from the current laboratory systems. By combining multiple analytic units in flexible ways, MODULARANALYTICSmet diverse laboratory needs and offered improvement in workflow over current laboratory situations. It increased overall efficiency while maintaining (or improving) quality.

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