Modern day health care systems rely heavily on laboratory investigations. Evidence based medicine is the norm nowadays and rightly so. More often than not, accurate investigations not only play a decisive role in a physician’s diagnosis but are also crucial for monitoring treatment.
It so happens that many a times patients/ doctors come across wrong or doubtful reports, thus creating a difficult choice for the physicians and anxiety to the patients, often leading to redoing the tests from the same or another diagnostic lab. While believing in one report and disregarding the other is often a random process, no time is wasted in incriminating the laboratory for the abnormal report.
Whose fault is it anyway and who guarantees that the same errors won’t happen the next time you or your loved ones go for a diagnostic test? It is important to know what exactly went wrong and where and why the lab in question failed to deliver a correct report.
Various kinds of laboratory errors can creep into the reports, right from the time of sample collection, transportation, processing, running of the actual test, and finally in entering or dispatching the reports. The errors, which happen even before the actual testing process, are known as pre-analytical errors.
Contrary to popular belief, it is during the pre-analytical phase that the most common errors occur, and not during the actual testing process in the labs. Laboratory science has seen significant advances in instrumentation and automation that have improved the accuracy, reproducibility and overall quality of reporting. Many laboratories invest considerable time and effort in maintaining quality control programs, participating in inspections, and complying with government regulations to overcome these errors.
It is estimated that almost two-thirds of the errors originate in the pre-analytic phase, and hence focusing on these errors would positively impact patient care, by avoiding unnecessary repetition of tests and ensuring accurate and timely test results. To prevent pre-analytic errors, the procedures for collection, handling, and processing prior to the analysis, as well as patient preparation for the tests needs to be addressed with great care.
Tests results are influenced by any of the patient variables such as diet, medications, exercise, pregnancy, smoking and dehydration. Some are controllable, some are not. The phlebotomist/technician must be aware of these influences and minimize the effects wherever possible. Eg – Collection of a blood sample from a patient in a fasting state and at rest minimizes the effect of diet and exercise.
Proper specimen collection by an expert phlebotomist is the most important controllable factor. Misidentification, insufficient or collection of incorrect volume blood to perform the test, specimens that are hemolyzed, clotted, contaminated, or collected in the wrong container account for a majority of the pre-analytic errors. Regular training of phlebotomists can nip these errors in the bud. Providing the phlebotomists with standard operating procedural documents at the point of use can go a long way in eliminating these errors.
Another potential error and mostly outside the control of a diagnostic laboratory is how a specimen is handled during the transit. Careful handling of the specimen during transit is imperative in maintaining the quality of a meticulously collected specimen. The means of transport, exposure to heat and cold, vibration, position of specimen tubes, and overall time of delivery can significantly affect test results. Laboratory has to continually review and update procedures and supplies to improve specimen quality and reduce specimen-handling errors. The lab has to evaluate all samples that arrive at the testing facility for analyte stability, acceptable specimen transport conditions, acceptable sample types, and storage time and temperature.
So, the next time when you have to undergo a laboratory test, do pay maximum attention to the below to minimize errors, delay and ambiguous reports!
- Know the pretest conditions required from the doctor.
- Get the blood collected from a certified phlebotomist/technician.
- Ensure the phlebotomist does the labelling of tubes before your eyes!
- Check for the transporting conditions/bag, if the tests are being done at a remote site!
- Chose the labs wisely not by blind trust! Check for the accreditation status of the lab rather than hearsay.