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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 / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
ISSN
1437-4331
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Volume 49, Issue 12

Issues

Chemistry and haematology sample rejection and clinical impact in a tertiary laboratory in Cape Town

Lourens A. Jacobsz
  • Division of Clinical Pathology, National Health Laboratory Service (NHLS), Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
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  • Other articles by this author:
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/ Annalise E. Zemlin
  • Division of Chemical Pathology, National Health Laboratory Service (NHLS), Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Mark J. Roos
  • Division of Haematological Pathology, National Health Laboratory Service (NHLS), Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
  • Deceased.
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Rajiv T. Erasmus
  • Division of Chemical Pathology, National Health Laboratory Service (NHLS), Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2011-10-14 | DOI: https://doi.org/10.1515/CCLM.2011.743

Abstract

Background: Recent publications report that up to 70% of total laboratory errors occur in the pre-analytical phase. Identification of specific problems highlights pre-analytic processes susceptible to errors. The rejection of unsuitable samples can lead to delayed turnaround time and affect patient care.

Methods: A retrospective audit was conducted investigating the rejection rate of routine blood specimens received at chemistry and haematology laboratories over a 2-week period. The reasons for rejection and potential clinical impact of these rejections were investigated. Thirty patient files were randomly selected and examined to assess the impact of these rejections on clinical care.

Results: A total of 32,910 specimens were received during the study period, of which 481 were rejected, giving a rejection rate of 1.46%. The main reasons for rejection were inappropriate clotting (30%) and inadequate sample volume (22%). Only 51.7% of rejected samples were repeated and the average time for a repeat sample to reach the laboratory was about 5 days (121 h). Of the repeated samples, 5.1% had results within critical values. Examination of patient folders showed that in 40% of cases the rejection of samples had an impact on patient care.

Conclusions: The evaluation of pre-analytical processes in the laboratory, with regard to sample rejection, allowed one to identify problem areas where improvement is necessary. Rejected samples due to factors out of the laboratory’s control had a definite impact on patient care and can thus affect customer satisfaction. Clinicians should be aware of these factors to prevent such rejections.

Keywords: audit; patient care; pre-analytical errors; rejection rate; turnaround time

About the article

Corresponding author: Lourens A. Jacobsz, MBChB, Division of Clinical Pathology, National Health Laboratory Service (NHLS), Tygerberg Hospital, University of Stellenbosch, PO Box 19113, Tygerberg 7505, Parow, South Africa Phone: +27-21-9384009, Fax: +27-21-9384640


Received: 2011-07-15

Accepted: 2011-09-17

Published Online: 2011-10-14

Published in Print: 2011-12-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 49, Issue 12, Pages 2047–2050, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2011.743.

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