Quality indicators to detect pre-analytical errors: a lighthouse in the night.

Scientific evidences demonstrate the negative impact of pre-analytical errors on patient safety and the use of quality indicators (QIs) as a strategic part of a quality improvement system in laboratory medicine. The coherent and standardized data collection of QIs is necessary to obtain a suitable data analysis and a prompt and effective implementation of corrective actions. This approach guarantees management focused on the patient. In this context our department, has implemented a QI system to monitor activities of the total testing process, performed by laboratory and non laboratory staff. In this work we report QI data, collected in the blood collection sites inside and outside the laboratory (clinical wards inside our hospital, CW; internal blood collection sites, CL; blood collection sites outside the hospital, BCO), from 2010 to 2013, concerning the unsuitable samples: haemolysed (H), with inadequate sample-anticoagulant volume ratio (R), clotted (C), with incorrect container (I): –– H, 0.334-0.558:(CW, 0.325-0.548; BCO, 0.002-0.003; CL, 0.007-0.008); –– R, 0.149-0.129:(CW, 0.147-0.124; BCO, 0.001-0.003; CL, 0.001-0.002); –– C, 0.094-0.066:(CW, 0.084-0.056; BCO, 0.006-0.005; CL, 0.004-0.005); –– I, 0.076-0.047:(CW, 0.069-0.042; BCO, 0.006- 0.003; CL, 0.001-0.001). The data highlighted a general and significant (p < 0.001) improvement over time for all error typologies, except for H samples, demonstrating the effectiveness of corrective actions implemented (release of operative procedures, staff training, periodic meetings, etc.). The increasing of H samples, due to the introduction, in August 2012, of automated detection of haemolysis degree confirms the arbitrariness and unreliability of visual detection. Moreover the higher percentages concern samples sent from sites outside the laboratory where work non laboratory staff (CW) in respect to the laboratory staff (CL and BCO). Therefore the use of QIs is today necessary to monitor and improve all activities performed inside and outside the laboratory walls.