Laboratory services play a crucial role in both individual and population-based healthcare. Lab tests are crucial to diagnose various conditions. What about errors? Laboratories are often prone to errors that can lead to inaccurate results. However, now most clinical laboratories invest considerable time and effort in maintaining quality control programs, participating in laboratory inspections, and complying with government regulations. The Centers for Medicare and Medicaid Services (CMS) regulates all laboratory tests performed on humans in the United States through the Clinical Laboratory Improvement Amendments (CLIA). The objective of the CLIA program is to ensure quality laboratory testing. Other bodies that inspect and set regulations on laboratory practices in the US include the Commission on Laboratory Accreditation, the Joint Commission and the College of American Pathologists.
There are various sources of errors in labs such as –
- Pre-analytic errors that include – patient variables, specimen variables (collection, handling, processing)
- Analytic – Performance of selected laboratory test
- Post-analytic – Test reporting variables such as recording, reporting and interpreting
Most errors are due to pre-analytical factors, while a high error rate has also been found in the post-analytical phase. Pre-analytical errors can occur at the time of patient assessment, test order entry, request completion, patient identification, specimen collection, specimen transport, or specimen receipt in the laboratory. Inappropriate use of laboratory test results, critical result reporting, and transmission of results are areas of potential error in the post-analytical phase of the total laboratory testing process. Errors can also occur as a result of inappropriate choice of laboratory tests, inadequate training and shortage of laboratory staff members and usage of less quality lab equipment.
Detection, identification, and monitoring of the errors and implementing strategies to improve pre-analytical quality reduce the number of errors, thus improving patient safety and health system outcomes. Certain tips to avoid lab errors include –
- Providing adequate training to medical laboratory personnel.
- The custom label system minimizes the potential oversight of forgetting to draw a tube, which happens frequently when operating without appointments, by printing the labels according to requested tests.
- Use checklists. Fewer errors are made in administering blood transfusions when blood bank technologists and transfusion nurses check off each procedure they perform on a standardized list.
- Develop clear written procedures that explain how to identify a patient, collect and label a specimen, and subsequently transport the specimen and prepare it for analysis.
- Ensure effective communication between laboratory staff members and other healthcare professionals such as doctors and nurses to determine the sources of errors as early as possible and take the necessary action to avoid them.
Automation is desirable and laboratories need to stay current on new opportunities. Recent advancements in laboratory technology have made available new and more reliable means of lab equipment such as automated analyzers, and quality blood collection sets to reduce medical laboratory errors. Technological solutions such as computerized order-entry systems, bar-coding identification of patients and related samples, and strategies for sharing information have the potential to make laboratory services safer and more efficient.