Study Of Key Quality Indicators For Clinical Laboratories:Venous Blood Collection Practice And Unaccepatable Specimen

ObjectiveThe aim of the study was to investigate the practice of venous blood collection(VBC)and the status of specimen management in the preanalytical phase,identify the main error issues in the process of VBC,determine the frequency and reasons for unacceptable specimen and preanalytical variables that might influence specimen acceptability,and provide advice to clinical laboratories.MethodsQuestionnaires were provided to clinical laboratories participating in the External Quality Assessment programs organized by the National Center for Clinical Laboratories in China.The questionnaire consisted of three parts:1)General features of participants:including the demographic data of participants and their practices on collection,transportation,handling and storage of specimen;2)VBC practice:participants ramdonly chose two phlebotomists from outpatient,inpatient and emergency department;3)Unaccepatable specimen:the received unaccepatable specimens were recorded form 1st to 31th July in 2017 for biochemistry and hematology.For each unaccepatable specimen,the following information were recorded,including source department,container type,container material type,specimen type,transportation method,phlebotomy personnel,time of specimen receipt,time of specimen rejection,reason for rejection,action taken,and time of specimen recollected or relabeled.Participating laboratories submitted the data via network and the collected data were analyzed via special statistical software.ResultsA total of 982(VBC practice),899(biochemistry specimen acceptability)and 890(hematology specimen acceptability)participants submitted their data,the response rate were 54.92%,56.05%and 56.12%,respectively.Majority of participants were third-class comprehensive hospitals.The most common VBC personnel were nurse,followed by laboratory personnel.The most common specimen transportation personnel were full-time transportation worker in inpatient and emergency department,and for outpatient department it was laboratory personnel.Only 18.76%participants monitored specimen transportation temperature.59.46%participants assigned special trained personnel to receive specimens,and 97.93%participants established rejection criteria for unacceptable specimen.The methods to determine and handle specimen of hemolysis and lipidemia/chylaemia were varied amony different laboratories.The major error issues were slap the puncture site and without draw a discard tube when a coagulation tube was the first tube drawn.The minor error issues were puncture before the disinfectant was evaporated,use tourniquet for more than 1 minute,insufficient blood volume and without inform patients not to bend the arm after collection.Total specimen rejection rate for biochemistry and hematology were 0.076%and 0.112%,and the total ? level were 4.67? and 4.56?,respectively.The main reasons for rejection in biochemistry were hemolysis(33.98%),insufficient specimen volume(10.78%)and lipidemia/chylaemia(10.62%)and in hematology were clotted(57.20%),insufficient specimen volume(13.99%)and inappropriate specimen-anticoagulant volume ratio(6.91%).For specimen rejection rate,outpatient was lower than emergency department,and emergency was lower than inpatient department.Compared to non-laboratory personnel,laboratory personnel had a lower rejection rate.Specimen transported by laboratory personnel also showed a lower rejection rate.The specimen processing delay in biochemistry was greater than which in hematology,and both showed emergency was lower than outpatient department and outpatient was lower than inpatient department.ConclusionsThe VBC practice was basically satisfied,but several error issues did exist and focus should be paid on it.The attention and management for unaccepatable specimen in preanalytical phase had strengthened,but there was still a big improvement space.Clinical laboratories and related responsible department were recommended to reinforce the training and assessment for VBC personnel to optimize the VBC practice,periodically monitor unaccepatable specimen and analyze related data at the most granular level,identify the main problem and take effective actions,so as to improve the quality in preanalytical phase.The platform established in the study will promote the long-term internal quality control and external quality assessment scheme.Through ongoing horizontal and longitudinal comparison,laboratory quality and patient safety could be continuously improved.