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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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Rank 5 out of 30 in category Medical Laboratory Technology in the 2014 Thomson Reuters Journal Citation Report/Science Edition

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Impact per Publication (IPP) 2015: 2.238

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“Pre-pre” and “post-post” analytical error: high-incidence patient safety hazards involving the clinical laboratory

Michael Laposata1 / Anand Dighe2

1Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

2Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Conflicts of interest: Drs. Laposata and Dighe are founding stockholders in American Medical Diagnostics.

Corresponding author: Michael Laposata, MD, PhD, Massachusetts General Hospital, 55 Fruit Street, GRJ 235, Boston, MA 02114, USA Phone: +1-617-7268172, Fax: +1-617-7263256,

Citation Information: Clinical Chemical Laboratory Medicine. Volume 45, Issue 6, Pages 712–719, ISSN (Online) 14374331, ISSN (Print) 14346621, DOI: 10.1515/CCLM.2007.173, June 2007

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Published Online:


Data from recent studies suggest that the highest incidence of laboratory-related errors occurs in the pre-analytical phase of laboratory testing. However, few studies have examined the frequency of errors in laboratory test selection and interpretation. A survey of physicians who use our clinical laboratory demonstrated that the largest number of test ordering errors appear to involve physicians simply ordering the wrong test. Diagnostic algorithms providing guidance for test selection in specific disorders are also used as the basis for the establishment of reflex protocols in the clinical laboratory. The provision of an expert-driven interpretation by laboratory professionals resulted in improvements both in the time to and the accuracy of diagnosis. A survey of our physician staff has shown that in the absence of such an interpretation, for patients being assessed for a coagulation disorder, approximately 75% of the cases would have involved some level of test result misinterpretation.

Clin Chem Lab Med 2007;45:712–9.

Keywords: diagnostic algorithms; laboratory errors; patient safety; post-analytical phase; pre-analytical phase; test interpretation; test selection

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