Common Mistakes Made in a Reference Lab
Reference labs are typically private, commercial facilities that perform high volume routine and speciality testing. Tests performed in these labs are typically referred from physicians’ offices, hospitals, and nursing homes where, while these facilities may be able to perform some tests, there are others that require specialized equipment.
As with any other type of lab, there are a number of common mistakes that can occasionally occur, however, there are four basic strategies that can be used to prevent errors: education, standardization, mistake-proofing, and streamlining. It is also important to identify the sources of common laboratory errors.
According to an article published in Laboratory Medicine, laboratory practices can be divided into three phases: pre-analytical, analytical, and post-analytical.
Pre-analytical
The pre-analytical phase is where most laboratory errors occur, and can occur at the time of assessment, test order entry, request completion, and specimen collection, transport, or receipt. Julie A. Hammerling of Florida Gulf Coast University argues that five-interrelated steps can help prevent pre-analytical errors:
- Develop clear written procedures
- Enhance health care professional training
- Automate functions, both for support operations and for executive operations
- Monitor quality indicators
- Improve communication among healthcare professionals and foster interdepartmental cooperation
Analytical
Test results in the analytical phase – which Hammerling defines as the time from “when the patient specimen is prepared in the laboratory for testing” until “the test result in interpreted and verified by the technologist in the laboratory” – can be affected if the specimen is not processed properly prior to analysis, or if substances interfere with the specimen during the testing procedure. By establishing and verifying test method performance specifications to test the following areas where laboratory errors commonly occur can help minimize the number of affected analysis:
- Accuracy
- Precision
- Sensitivity
- Linearity
Post-Analytical
During the post-analytical phase of testing, results are released to the clinician, who then interprets them in order to make diagnostic and therapeutic decisions. Areas of potential error in this phase include:
- Inappropriate use of test results
- Critical result reporting
- Transmission of correct results
Unfortunately for labs, the majority of these issues are out of their hands in terms of how the results of the tests are ultimately used to treat the patients. However, if they’ve done their due diligence in the first two stages, the outcome will hopefully ultimately be positive.
