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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 / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

13 Issues per year

IMPACT FACTOR 2013: 2.955
Rank 5 out of 29 in category Medical Laboratory Technology in the 2013 Thomson Reuters Journal Citation Report/Science Edition

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Preanalytical quality improvement: from dream to reality

1 / Jeffrey J. Chance2 / Stephen Church3 / Paola Dazzi1 / Rossana Fontana1 / Davide Giavarina4 / Kjell Grankvist5 / Wim Huisman6 / Timo Kouri7 / Vladimir Palicka8 / Mario Plebani9 / Vincenzo Puro10 / Gian Luca Salvagno11 / Sverre Sandberg12 / Ken Sikaris13 / Ian Watson14 / Ana K. Stankovic2 / Ana-Maria Simundic15

1Clinical Chemistry and Hematology Laboratory, Academic Hospital of Parma, Parma, Italy

2Medical and Clinical Affairs, BD Diagnostics – Preanalytical Systems, Franklin Lakes, NJ, USA

3Medical and Clinical Affairs, BD Diagnostics – Preanalytical Systems, Oxford, UK

4Clinical Chemistry and Hematology Laboratory, Hospital of Vicenza, Vicenza, Italy

5Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden

6Medical Centre Haaglanden, Department of Clinical Chemistry, The Hague, The Netherlands and Chair of the EFCC Working Group on Accreditation

7HUSLAB, Helsinki University Hospital Laboratories, Helsinki, Finland

8Institute of Clinical Biochemistry and Diagnostics, Charles' University of Prague, Prague, Czech Republic

9Department of Laboratory Medicine, Academic Hospital of Padova and Leonardo Foundation, Abano Terme General Hospital (PD), Padova, Italy

10Department of Epidemiology, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy and Studio Italiano Rischio Occupazionale da HIV (SIROH)

11Clinical Biochemistry Laboratory, Department of Life and Reproduction Sciences, University Hospital of Verona, Verona, Italy

12Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway

13Chemical Pathology, Sonic Health – Melbourne Pathology, Melbourne, Australia

14Department of Clinical Biochemistry, University Hospital Aintree, Liverpool, UK

15Clinical Institute of Chemistry, University Hospital “Sestre Milosrdnice”, Zagreb, Croatia

Corresponding author: Prof. Giuseppe Lippi, U.O. Diagnostica Ematochimica, Azienda Ospedaliero – Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy Phone: +39-0521-703050/703791

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 49, Issue 7, Pages 1113–1126, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2011.600, April 2011

Publication History

Published Online:


Laboratory diagnostics (i.e., the total testing process) develops conventionally through a virtual loop, originally referred to as “the brain to brain cycle” by George Lundberg. Throughout this complex cycle, there is an inherent possibility that a mistake might occur. According to reliable data, preanalytical errors still account for nearly 60%–70% of all problems occurring in laboratory diagnostics, most of them attributable to mishandling procedures during collection, handling, preparing or storing the specimens. Although most of these would be “intercepted” before inappropriate reactions are taken, in nearly one fifth of the cases they can produce inappropriate investigations and unjustifiable increase in costs, while generating inappropriate clinical decisions and causing some unfortunate circumstances. Several steps have already been undertaken to increase awareness and establish a governance of this frequently overlooked aspect of the total testing process. Standardization and monitoring preanalytical variables is of foremost importance and is associated with the most efficient and well-organized laboratories, resulting in reduced operational costs and increased revenues. As such, this article is aimed at providing readers with significant updates on the total quality management of the preanalytical phase to endeavour further improvement for patient safety throughout this phase of the total testing process.

Keywords: errors; laboratory diagnostics; patient safety; preanalytical phase; quality

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