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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.

12 Issues per year

IMPACT FACTOR 2016: 3.432

CiteScore 2016: 2.21

SCImago Journal Rank (SJR) 2016: 1.000
Source Normalized Impact per Paper (SNIP) 2016: 1.112

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Volume 45, Issue 6 (Jun 2007)


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

Michael Laposata
  • 1Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
/ Anand Dighe
  • 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.
Published Online: 2007-06-19 | DOI: https://doi.org/10.1515/CCLM.2007.173


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

About the article

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,

Published Online: 2007-06-19

Published in Print: 2007-06-01

Citation Information: Clinical Chemical Laboratory Medicine, ISSN (Online) 14374331, ISSN (Print) 14346621, DOI: https://doi.org/10.1515/CCLM.2007.173.

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