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Patient-centred care - preanalytical factors demand attention: a questionnaire study of venous blood sampling and specimen handling
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
Umeå University, Faculty of Medicine, Department of Nursing.
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2007 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, Vol. 67, no 8, 836-847 p.Article in journal (Refereed) Published
Abstract [en]

Objective. Most mistakes in laboratory medicine are the result of human error occurring before the blood sample reaches the laboratory. This survey of preanalytical procedures was designed to identify sources of error and potential targets for quality improvement strategies.

Material and methods. The staff in a highly specialized surgical ward at a university hospital completed a questionnaire addressing the collection and handling of venous blood samples in plastic vacuum test‐tubes for general clinical chemistry testing.

Results. The results suggest that venous blood sampling instructions are not always followed. When uncertain about how a sample should be collected, the majority of respondents rely on potentially poor sources of information, such as out‐of‐date printed instructions or the advice of a colleague, rather than consult up‐to‐date electronic instructions. Furthermore, they do not always report errors and the referrals are not always handled according to sampling instructions. The respondents were highly motivated, however, and had a strong interest in receiving further education in, and assuming increased responsibility for, venous blood sampling procedures in the ward.

Conclusions. We believe that the introduction of standardized routines and regular staff training, combined with an exchange of the existing paper‐based referral management system with an electronic system for managing referrals, could increase safety in the preanalytical process, with positive effects on patient safety. Given the importance of venous blood samples in patient care, a more extensive study covering other hospital wards and primary health‐care centres is needed.

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Place, publisher, year, edition, pages
2007. Vol. 67, no 8, 836-847 p.
Keyword [en]
Blood specimen collection, guideline adherence, medical errors, patient-centred care, phlebotomy, quality of health care, questionnaires, safety management, specimen handling
National Category
Biomaterials Science
URN: urn:nbn:se:umu:diva-6720DOI: 10.1080/00365510701370675PubMedID: 17852838OAI: diva2:146390
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2012-02-03Bibliographically approved
In thesis
1. Preanalytical errors in hospitals: implications for quality improvement of blood sample collection
Open this publication in new window or tab >>Preanalytical errors in hospitals: implications for quality improvement of blood sample collection
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Most errors in the venous blood testing process are preanalytical, i.e. they occur before the sample reaches the laboratory. Unlike the laboratory analysis, the preanalytical phase involves several error-prone manual tasks not easily avoided with technological solutions. Despite the importance of the preanalytical phase for a correct test result, little is known about how blood samples are collected in hospitals.

Aim: The aim of this thesis was to survey preanalytical procedures in hospitals to identify sources of error.

Methods: The first part of this thesis was a questionnaire survey. After a pilot study (Paper I), a questionnaire addressing clinical chemistry testing was completed by venous blood sampling staff (n=314, response rate 94%) in hospital wards and hospital laboratories (Papers II–IV). The second part of this thesis was an experimental study. Haematology, coagulation, platelet function and global coagulation parameters were compared between pneumatic tube-transported samples and samples that had not been transported (Paper V).

Results: The results of the questionnaire survey indicate that the desirable procedure for the collection and handling of venous blood samples were not always followed in the wards (Papers II–III). For example, as few as 2.4% of the ward staff reported to always label the test tube immediately before sample collection. Only 22% of the ward staff reported to always use wristbands for patient identification, while 18% reported to always use online laboratory manuals, the only source of updated information. However, a substantial part of the ward staff showed considerable interest in re-education (45%) and willingness to improve routines (44%) for venous blood sampling. Compared to the ward staff, the laboratory staff reported significantly higher proportions of desirable practices regarding test request management, test tube labelling, test information search procedures, and the collection and handling of venous blood samples, but not regarding patient identification. Of the ward staff, only 5.5% had ever filed an error report regarding venous blood sampling, compared to 28% of the laboratory staff (Paper IV). In the experimental study (Paper V), no significant preanalytical effect of pneumatic tube transport was found for most haematology, coagulation and platelet function parameters. However, time-to-clot formation was significantly shorter (16%) in the pneumatic tube-transported samples, indicating an in vitro activation of global coagulation.

Conclusions. The questionnaire study of the rated experiences of venous blood sampling ward staff is the first of its kind to survey manual tasks in the preanalytical phase. The results suggest a clinically important risk of preanalytical errors in the surveyed wards. Computerised test request management will eliminate some, but not all, of the identified risks. The better performance reported by the laboratory staff may reflect successful quality improvement initiatives in the laboratories. The current error reporting system needs to be functionally implemented. The experimental study indicates that pneumatic tube transport does not introduce preanalytical errors for regular tests, but manual transport is recommended for analysis with thromboelastographic technique. This thesis underscores the importance of quality improvement in the preanalytical phase of venous blood testing in hospitals.

Place, publisher, year, edition, pages
Umeå: Medicinsk biovetenskap, 2008. 64 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1177
medical errors, preanalytical, quality improvement, questionnaire, venous blood sampling
National Category
Other Clinical Medicine
urn:nbn:se:umu:diva-1672 (URN)978-91-7264-562-2 (ISBN)
Public defence
2008-06-13, Hörsal Betula, Norrlands Universitetssjukhus, 901 85, Umeå, 09:00 (English)
Available from: 2008-05-21 Created: 2008-05-21 Last updated: 2011-01-25Bibliographically approved

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