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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

Editorial Board Member: Gillery, Philippe / Kazmierczak, Steven / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Whitfield, John B.

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Preanalytical mistakes in samples from primary care patients

Adolfo Romero1 / Andrés Cobos1 / Ana López-León2 / Germán Ortega3 / Manuel Muñoz4

1Clinical Laboratory, University Hospital Virgen de la Victoria, Málaga, Spain

2Guadalhorce Primary Health Care District, Málaga, Spain

3Málaga Primary Health Care District, Málaga, Spain

4GIEMSA, School of Medicine, Málaga, Spain

Corresponding author: Adolfo Romero, Sede Provincial SATSE, C/La Regente 20 Bajo B, 29007 Málaga, Spain Phone: +34 677 215 287, Fax: +34 952 303 119,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 47, Issue 12, Pages 1549–1552, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2009.338, December 2009

Publication History

Received:
2009-05-27
Accepted:
2009-08-03

Abstract

Background: Preanalytical mistakes (PAMs) in samples usually led to rejection upon arrival to the clinical laboratory. However, PAMs might not always be detected and result in clinical problems. Thus, PAMs should be minimized. We detected PAMs in samples from Primary Health Care Centres (PHCC) served by our central laboratory. Thus, the goal of this study was to describe the number and types of PAMs, and to suggest some strategies for improvement.

Methods: The presence of PAMs, as sample rejection criteria, in samples submitted from PHCC to our laboratory during October and November 2007 was retrospectively analysed.

Results: Overall, 3885 PAMs (7.4%) were detected from 52,669 samples for blood analyses. This included missed samples (n=1763; 45.4% of all PAMs, 3.3% of all samples), haemolysed samples (n=1408; 36.2% and 2.7%, respectively), coagulated samples (n=391; 10% and 0.7%, respectively), incorrect sample volume (n=110; 2.8% and 0.2%, respectively), and others (n=213; 5.5% and 0.4%, respectively). For urine samples (n=18,852), 1567 of the samples were missing (8.3%).

Conclusions: We found the proportion of PAMs in blood and urine samples to be 3-fold higher than that reported in the literature. Therefore, strategies for improvement directed towards the staff involved, as well as an exhaustive audit of preanalytical process are needed. To attain this goal, we first implemented a continued education programme, financed by our Regional Health Service and focused in Primary Care Nurses.

Clin Chem Lab Med 2009;47:1549–52.

Keywords: blood sampling; mistake detection; preanalytical mistakes; primary health care

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