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Accessible Unlicensed Requires Authentication Published by De Gruyter October 2, 2014

Preanalytical errors: a preliminary approach to the point of view of primary health care givers

Juan Gómez-Salgado, Adolfo Romero, Isabel S. Caparrós, M. Carmen Barba, Margarita Reina and Carlos Ruiz-Frutos


Background: The presence of errors in the preanalytical phase is a widely studied topic. However, information regarding the perspective of those professionals involved is rather scant.

Methods: Two focus groups of professionals from Primary Care involved in the preanalytical phase (general practitioners [GP], community nurses [CN], and other auxiliary health workers, including administrative personnel [AHW]) were convened. A qualitative analysis with a phenomenological approach was performed by using the structure of SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis as a guide, and results were categorized by grouping the resultant dimensions according to this structure.

Results: Overall, 12 professionals (3 GP, 6 CN, and 3 AHW) were distributed in two groups. Age and gender distribution were similar between groups. The most commented strengths were organizational capability and teamwork. The main weakness was the workload increase (compared to the short time spent on sample collection). Opportunities were related to workload optimization through on-line analytical requests. Threats were related to the long time elapsed between sample drawing at Primary Care and delivery to the Central Laboratory.

Conclusions: The phenomenological approach allows revealing those aspects that cannot be entirely elucidated by objective data measurement. Attitudes considered as positive can be exploited by the institution, whereas those considered as negative alert us to possible future problems. Primary Care professionals offered a different point of view to laboratory staff, but both recognized high workload as the main threat and on-line analytical request as the best opportunity. These perspectives may help to improve detection and decrease the number of errors.

Corresponding author: Adolfo Romero, Haematology Department, Hospital Universitario Virgen de la Victoria, Campus de Teatinos s/n., 29010 Málaga, Spain, Phone: +34 951 032 302, Fax: +34 951 032 596, Cell number: +34 617 32 83 00, E-mail:


The authors wish to thank Manuel Muñoz, GIEMSA, School of Medicine, University of Málaga, Spain, for his collaboration in translation and revision of the manuscript.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Financial support: This study was partially supported by project Fondo de Investigaciones Sanitarias (FIS) grant PI FIS 1099/12 from “Instituto de Salud Carlos III” Ministerio de Sanidad y Política Social. Gobierno de España. (Health Ministry, Spanish Government).

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


1. Plebani M, Carraro P. Mistakes in a stat laboratory: types and frequency. Clin Chem 1997;43:1348–51.Search in Google Scholar

2. Wiwanitkit V. Types and frequency of preanalytical mistakes in the first Thai ISO 9002: 1994 certified clinical laboratory, a 6-month monitoring. BMC Clin Pathol 2001;1:5.Search in Google Scholar

3. Carraro P, Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Clin Chem 2007;53:1338–42.Search in Google Scholar

4. Bonini PA, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine. Clin Chem 2002;48:691–8.Search in Google Scholar

5. Carraro P. Servidio P, Plebani M. Hemolyzed specimens: a reason for rejection or clinical challenge? Clin Chem 2000;46:306–7.Search in Google Scholar

6. Romero Ruiz A, Tronchoni de los Llanos J, Sanchez Negrete J. Valoracion de la aparicio n de hemolisis con tres sistemas diferentes de extracción sangu?’nea. Rev Enferm 2004;27:19–22.Search in Google Scholar

7. Ellis G. An episode of increased hemolysis due to a defective pneumatic air tube delivery system. Clin Biochem 2009;42: 1265–9.Search in Google Scholar

8. Stankovic AK. The laboratory is a key partner in assuring patient safety. Clin Lab Med 2004;24:1023–35.Search in Google Scholar

9. Kalra J. Medical errors: impact on clinical laboratories and other critical areas. Clin Biochem 2004;37:1052–62.Search in Google Scholar

10. Garon JE. Patient safety and the preanalytic phase of testing. Clin Leadersh Manag Rev 2004;18:322–7.Search in Google Scholar

11. Institute of Medicine. To err is human: building a safer health system. Brief summary. 1999. Avalaible from: HYPERLINK “. Accessed “. Accessed Dec 12, 2013.Search in Google Scholar

12. Wallin O, Söderberg J, Van Guelpen B, Brulin C, Grankvist K. Patient-centred care – preanalytical factors demand attention: a questionnaire study of venous blood sampling and specimen handling. Scand J Clin Lab Invest 2007;67:836–47.Search in Google Scholar

13. Söderberg J, Brulin C, Grankvist K, Wallin O. Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling. Clin Chem Lab Med 2009;47:195–201.Search in Google Scholar

14. Söderberg J, Jonsson PA, Wallin O, Grankvist K, Hultdin J. Haemolysis index – an estimate of preanalytical quality in primary health care. Clin Chem Lab Med 2009;47:940–4.Search in Google Scholar

15. Söderberg J, Grankvist K, Brulin C, Wallin O. Incident reporting practices in the preanalytical phase: low reported frequencies in the primary health care setting. Scand J Clin Lab Invest 2009;69:731–5.Search in Google Scholar

16. Söderberg J, Wallin O, Grankvist K, Brulin C. Is the test result correct? A questionnaire study of blood collection practices in primary health care. J Eval Clin Pract 2010;16:707–11.Search in Google Scholar

17. Wallin O, Söderberg J, Van Guelpen B, Stenlund H, Grankvist K, Brulin C. Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories. Scand J Caring Sci 2010;24:581–91.Search in Google Scholar

18. Plebani M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem 2010;47:101–10.Search in Google Scholar

19. Carraro P, Zago T, Plebani M. Exploring the initial steps of the testing process: frequency and nature of pre-preanalytic errors. Clin Chem 2012;58:3638–42.Search in Google Scholar

20. Gómez-Salgado J, Romero A, Cobos A, Caparrós IS, Gómez-Fernández JA, Dominguez JA, et al. Preanalytical errors: the professionals’ perspective. Clin Chem Lab Med 2014;52: e53–5.Search in Google Scholar

21. van Wijngaarden JD, Scholten GR, van Wijk KP. Strategic analysis for health care organizations: the suitability of the SWOT-analysis. Int J Health Plann Mgmt 2012;27:34–49.Search in Google Scholar

22. Ghazinoory S, Abdi M, Azadegan-Mehr M. SWOT methodology: a state-of-the-art review for the past, a framework for the future. J Business Economics Management 2011;12:24–48.Search in Google Scholar

Received: 2014-5-31
Accepted: 2014-9-8
Published Online: 2014-10-2
Published in Print: 2015-2-1

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