A STUDY ON BLOOD SAMPLE REJECTION AS A QUALITY INDICATOR FOR CONTINUAL IMPROVEMENT OF LABORATORY SERVICES IN A TERTIARY CARE TEACHING HOSPITAL IN BANGALORE.
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Keywords
Rejection rate, Pre analytical error, Hematology, Blood sample, Sample collection, Quality indicator.
Abstract
Background : In a diagnostic laboratory, there are 3 phases of analysis : Pre-analytical, Analytical and Post-analytical. Any Error in these phases can lead to erroneous results and it will compromise the patient management . To ensure that samples are suitable for testing sample rejection criterias are used as a quality indicator for prevention of invalid wrong results. In all the labs, precision, accuracy, and short turnaround time (TAT) are important in effective emergency laboratory services. Laboratory test results where pre analytical errors are there will cause repeat collections in patients and will delay the major clinical decisions. Identification of problem areas and continuous training of phlebotomy staff and ward nurses are important tools in reducing these errors.
Materials and method : Details of all rejected blood samples were recorded using the data sheets for each rejected samples from the Hematology, Biochemistry and Microbiology sections in the laboratory. Our lab has a defined policy for sample rejection based on a list of criteria identified by the lab for rejection.
Objective: 1. This study is done in order to analyse the sample rejection rates from each section of the laboratory including Hematology, Biochemistry and Microbiology according to the types of pre analytical errors.
- To monitor the Sample Rejections rate as a Quality Indicator for Continual improvement of the Laboratory.
Result: Total of 230 Rejected Blood Samples were included in the study which were rejected during the period from 01/01/24 to 31/07/24 out of Total 58631 blood samples received. Clotted samples was most frequently rejected sample in hematology section (34%) followed by insufficient volume (6.5%) and hemolysed samples(3.9%). In Microbiology lab, most frequent rejection was due to hemolysed sample(7.8%) followed by volume insufficiency in serology(3.4%) followed by leakage samples (0.8%). In Biochemical tests the most frequent rejection reasons were hemolysed samples (28%) and inadequate volume (9%).
Conclusion : The knowledge of nurses and technicians regarding sample collection in some aspects are needed. Continuing education and training programmes for the technicians and nurses to enhance the quality of blood sample collection and evaluation for the effectiveness is emphasized.
Taking preventive & corrective actions to reduce the sample rejection rate in daily practice definitely improves the quality of the laboratory results and is a quality indicator for continual improvement of the laboratory.
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Dr. Jaya Maisnam
Associate Professor Department of Pathology, The Oxford medical college research centre and hospital, Bangalore.
Dr. Abirami P
Associate Professor Department of microbiology, The Oxford medical college research centre and hospital, Bangalore.
Dr. Afshan Gulruq Rahmath
Assistant Professor Department of microbiology, The Oxford medical college research centre and hospital, Bangalore