Errors in laboratory medicine: The role of quality indicators (original) (raw)
Related papers
Quality-Improvement Measures as Effective Ways of Preventing Laboratory Errors
Laboratory Medicine, 2014
Laboratory error is defined as any defect from ordering tests to reporting and interpretation of results. Laboratory errors have a reported frequency of 0.012-0.6% of all test results which in turn has huge impact on diagnosis and patient management as 60-70% of all diagnosis are made on the basis of laboratory tests. Total testing process in the laboratory is a cyclical process divided into three phases: preanalytical, analytical and postanalytical. First, preanalytical phase in which requirement for a test is determined, the test is ordered and the patient is identified. It is followed by specimen collection and transport to the laboratory. The specimen is prepared and tested in the analytical phase. During the postanalytical phase, the results are reported to the individual who ordered the test and any action or intervention is undertaken. Initially, the policies and procedures developed by the laboratory were more concerned on analytical phase to reduce errors during laboratory testing and emphasis was in ensuring proper calibration and testing. The last few decades have seen a significant decrease in the rates of analytical errors in clinical laboratories. Currently, available evidences demonstrate that the pre-and postanalytical steps are more error prone.
Clinical Chemistry and Laboratory Medicine, 2017
The knowledge of error rates is essential in all clinical laboratories as it enables them to accurately identify their risk level, and compare it with those of other laboratories in order to evaluate their performance in relation to the State-of-the-Art (i.e. benchmarking) and define priorities for improvement actions. Although no activity is risk free, it is widely accepted that the risk of error is minimized by the use of Quality Indicators (QIs) managed as a part of laboratory improvement strategy and proven to be suitable monitoring and improvement tools. The purpose of QIs is to keep the error risk at a level that minimizes the likelihood of patients. However, identifying a suitable State-of-the-Art is challenging, because it calls for the knowledge of error rates measured in a variety of laboratories throughout world that differ in their organization and management, context,
Clinical Chemistry and Laboratory Medicine
Data on quality indicators (QIs) should be collected over time in order to identify and continuously monitor clinical laboratory performance and to improve patient safety by identifying and implementing effective interventions. The aim of the present study was to ascertain whether the utilization of a set of quality indicators over a 3-year period resulted in an improvement in the efficiency and effectiveness of an individual laboratory. Over a 3-year time interval (2009-2011), a series of 38 QIs covering all stages of the total testing process (21 in the pre-analytic, nine in the analytic and eight in the post-analytic phase) was monitored. On the basis of their patterns, QIs have been grouped into the following categories: [1] seven QIs of the pre-analytical phase and three of the intra-analytical phase with a significant trend and a significant linearity demonstrating an improvement over time; [2] 10 QIs of the pre-analytical and two of the intra-analytical phase with a significa...
Quality indicators in laboratory medicine: A fundamental tool for quality and patient safety
Clinical Biochemistry, 2013
Objectives: The identification of reliable quality indicators (QIs) is a crucial step in enabling users to quantify the quality of laboratory services. The current lack of attention to extra-laboratory factors is in stark contrast with the body of evidence pointing to the multitude of errors that continue to occur in the pre-and post-analytical phases.
Management of errors in a clinical laboratory
Clinical laboratories focus their attention on quality control methods. However, such quality control cannot be assured by merely focusing on analytical aspects as both pre-analytical and post-analytical phases must be considered as well. This article analyses the causes of errors occurring in clinical laboratories by evaluating literature data and statistics from the " AMES " poly-diagnostic centre in Naples.
Clinica Chimica Acta, 2019
Quality indicators (QIs) are key tools for improving the quality of laboratory services, by reducing error rates and safeguarding patient safety. A body of accumulated evidence confirms the relevance of QIs and their impact on the overall quality of laboratory information. The consensus achieved on a list of "harmonized" QIs, along with the system used for data collection and reporting throughout an international benchmarking programme, has enabled achieving realistic performance targets, based on knowledge of the state-of-the-art. Data collected in 2017 and 2018 have been analyzed and performance measures obtained by laboratories participating in the project are summarized in the present article. The laboratory performance measures have been classified into three levels (optimum, desirable or minimum) in agreement with the widely accepted model of analytical quality specifications.
Identifying Errors Involving Clinical Laboratory: A 1 Year Study
International Journal of Health Sciences and Research, 2014
OBJECTIVE: It is a known fact that in modern day, laboratory diagnosis is the cornerstone of health care system. It is seen that pre and post analytical phases in a testing cycle contribute majority of the laboratory errors. This study was conducted to recognize the errors that occurs in the three phases of the testing cycle and for improvement in the areas where required. METHODS: The present study was conducted during the period 2012-13 in the central laboratory in M.G.M. Hospital and Medical College. During a 12 month period 97,618 samples were monitored for major pre analytical, analytical and post analytical errors RESULTS: From the study it was documented that total errors were 14,149 of which pre-analytical were 9,867 (69.7%), analytical were 751 (5.3%) and post-analytical were 3,531 (25%). CONCLUSION: Our study showed that most of the errors pre-analytical either during sampling or preparation for analysis. The continuous improvement of the phases of testing cycle seems to b...
Assessment of laboratory errors and best laboratory practices
International Journal of Bioassays, 2016
Laboratory error is defined by ISO 22367 as “Failure of planned actions to be completed as intended or use a wrong plan to achieve an aim”. Lundeberg in 1981 outlined the concept of Total Testing Process (TTP) and Plebani elaborated it further and classified the whole testing process into five phases of Pre-Pre Analytic, Pre Analytic, Analytic, Post Analytic and Post - Post Analytic. The errors have to be identified and resolved in each phase of the process. The medical laboratories have to run Internal and External Quality Control programs and abide by the guidelines of ISO 15189 in order to be accredited by bodies like JCI, CAP or NABL. Active communication and regular interaction between the clinicians and the laboratory is recommended during Pre Analytic and Post Analytic phases of TTP in order to achieve the target of Best Laboratory Practices.
Harmonization of quality indicators in laboratory medicine. A preliminary consensus
Clinical Chemistry and Laboratory Medicine, 2014
Quality indicators (QIs) are fundamental tools for enabling users to quantify the quality of all operational processes by comparing it against a defined criterion. QIs data should be collected over time to identify, correct, and continuously monitor defects and improve performance and patient safety by identifying and implementing effective interventions. According to the international standard for medical laboratories accreditation, the laboratory shall establish and periodically review QIs to monitor and evaluate performance throughout critical aspects of pre-, intra-, and post-analytical processes. However, while some interesting programs on indicators in the total testing process have been developed in some countries, there is no consensus for the production of joint recommendations focusing on the adoption of universal QIs and common terminology in the total testing process. A preliminary agreement has been achieved in a Consensus Conference organized in Padua in 2013, after revising the model of quality indicators (MQI) developed by the Working Group on "Laboratory Errors and Patient Safety" of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). The consensually accepted list of QIs, which takes into consideration both their importance and applicability, should be tested by all potentially interested clinical laboratories to identify further steps in the harmonization project.