An audit of pre-analytical errors and specimen rejection in the haematology laboratory of a tertiary care transplant center: Clinical and financial impact: Root cause analysis of specimen rejection in haematology laboratory.

Abstract

Objective: To identify specific problems regarding pre-analytic processes susceptible to errors and their impact on sample rejection in a haematology laboratory. Study Design: A retrospective audit. Setting: The study was conducted at the Haematology laboratory of the Pakistan Kidney and Liver Institute and Research Center (PKLI&RC). Period: The audit covered a four-year period from 2019 to 2022. Methods: A retrospective audit of all samples rejected in the Haematology laboratory was performed. The reasons for rejection and the potential clinical impact of these rejections were investigated. The study was approved by the Institutional Review Board (IRB) of PKLI&RC (Ref No.: PKLI-IRB/AP/110, Approval date: 28 March 2023). Results: Out of 250,000 samples received, 568 specimens were rejected, yielding a rejection rate of 0.22%. The most common reasons for rejection were clotted samples (n=274, 48%), results not matching the patient's given history (n=142, 25%), hemolyzed samples (n=40, 7%), insufficient quantity (QNS) (n=34, 5.9%), vial defects (n=15, 2.6%), patient identification errors (n=6, 1%), and sample switches (n=4, 0.7%). Conclusion: The implementation of a barcoding system and positive patient ID can help prevent mislabelling and patient ID issues. Proper training and continuing education for all healthcare professionals involved in collecting, handling, and transporting patient samples is crucial to the mitigation of pre-analytical errors. Standardization of processes and procedures can efficiently prevent pre-analytical errors.