EVALUATION OF PRE-ANALYTIC AND POST-ANALYTIC PHASES OF THE COAGULATION LABORATORY IN HACETTEPE UNIVERSITY HOSPITALS
(Abstract release date: 05/19/16)
EHA Library. Akbiyik F. 06/09/16; 135003; PB2103
Prof. Filiz Akbiyik
Contributions
Contributions
Abstract
Abstract: PB2103
Type: Publication Only
Background
The pre-analytical and post-analytical phase in a test cycle contributes up to 93% of total laboratory errors. Our coagulation laboratory provides routine and stat tests for inpatients and outpatients in Hacettepe University Hospitals, including 1000 beds. Joint Commission International guidelines is followed in our laboratory; we document the unsuitable samples rejected by laboratory and we record critical value notifications, including the person who received the notification (physician, nurse or medical staff), the time and the date of communication. Hence, rejection of unsuitable samples and critical value notification are the quality indicators of our laboratory.
Aims
In this study, we aimed to evaluate the pre-analytical problems and critical values recorded on coagulation and hemostasis tests over one year period in 2015.
Methods
Venous blood samples for routine coagulation testing were considered unsuitable for analysis according to the following specimen rejection criteria of our laboratory; inappropriate clinical orders, inappropriate volume (inadequate blood to anticoagulant ratio), incorrect tube, clotting, delayed transport and visible hemolysis or fibrin following centrifugation.During day time and night shift, authorized laboratory secretary was responsible for reporting of critical values by telephone communication and reverse reading. The critical values in our laboratory were as follows; prothrombin time/international normalized ratio (PT/INR)>5, activated partial thromboplastin time (aPTT)>100 seconds, fibrinogen<100 mg/dL, factor levels<5% and anti-thrombin III<50%.
Results
Total coagulation test request was 155.945 in one year and 5.090 tubes were rejected according to the rejection criteria of our laboratory. On overall, the more frequent pre-analytical problems could be referred as clotting (38.4%), following inappropriate volume (33.2%), inappropriate clinical orders (7.3%), misidentification (6.5%), hemolysis (6%), incorrect tube (3.8%), fibrin (3.3%) and delayed transport (1.5%), respectively.Among 155.945 tests performed in 2015, we reported 475 critical values, the ratio was 0.3% in total. The critical value notification ratio was 56% for INR, 23% for factor levels, 12.2% for fibrinogen, 5.5% for antithrombin III and 3% for aPTT. The critical value reporting rate was 97-99%, dropped call ratio was approximately 1-3% of all.
Conclusion
We detected an overall specimen rejection rate of 3.2% in coagulation laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 1% and to improve total quality management of the laboratory. Our critical value reporting rate was 97-99%, and clinicians were notified of patients’ life-threatening results within 15 minutes. We believe that rapid notification of abnormal test results has an impact on patient outcomes. This is the first report on the pre-analytical and post-analytical phases of coagulation laboratory in Turkey. To improve patient outcome, each laboratory has to establish its own specimen rejection criterias and reporting policy for critical values.
Session topic: E-poster
Keyword(s): Blood coagulation
Type: Publication Only
Background
The pre-analytical and post-analytical phase in a test cycle contributes up to 93% of total laboratory errors. Our coagulation laboratory provides routine and stat tests for inpatients and outpatients in Hacettepe University Hospitals, including 1000 beds. Joint Commission International guidelines is followed in our laboratory; we document the unsuitable samples rejected by laboratory and we record critical value notifications, including the person who received the notification (physician, nurse or medical staff), the time and the date of communication. Hence, rejection of unsuitable samples and critical value notification are the quality indicators of our laboratory.
Aims
In this study, we aimed to evaluate the pre-analytical problems and critical values recorded on coagulation and hemostasis tests over one year period in 2015.
Methods
Venous blood samples for routine coagulation testing were considered unsuitable for analysis according to the following specimen rejection criteria of our laboratory; inappropriate clinical orders, inappropriate volume (inadequate blood to anticoagulant ratio), incorrect tube, clotting, delayed transport and visible hemolysis or fibrin following centrifugation.During day time and night shift, authorized laboratory secretary was responsible for reporting of critical values by telephone communication and reverse reading. The critical values in our laboratory were as follows; prothrombin time/international normalized ratio (PT/INR)>5, activated partial thromboplastin time (aPTT)>100 seconds, fibrinogen<100 mg/dL, factor levels<5% and anti-thrombin III<50%.
Results
Total coagulation test request was 155.945 in one year and 5.090 tubes were rejected according to the rejection criteria of our laboratory. On overall, the more frequent pre-analytical problems could be referred as clotting (38.4%), following inappropriate volume (33.2%), inappropriate clinical orders (7.3%), misidentification (6.5%), hemolysis (6%), incorrect tube (3.8%), fibrin (3.3%) and delayed transport (1.5%), respectively.Among 155.945 tests performed in 2015, we reported 475 critical values, the ratio was 0.3% in total. The critical value notification ratio was 56% for INR, 23% for factor levels, 12.2% for fibrinogen, 5.5% for antithrombin III and 3% for aPTT. The critical value reporting rate was 97-99%, dropped call ratio was approximately 1-3% of all.
Conclusion
We detected an overall specimen rejection rate of 3.2% in coagulation laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 1% and to improve total quality management of the laboratory. Our critical value reporting rate was 97-99%, and clinicians were notified of patients’ life-threatening results within 15 minutes. We believe that rapid notification of abnormal test results has an impact on patient outcomes. This is the first report on the pre-analytical and post-analytical phases of coagulation laboratory in Turkey. To improve patient outcome, each laboratory has to establish its own specimen rejection criterias and reporting policy for critical values.
Session topic: E-poster
Keyword(s): Blood coagulation
Abstract: PB2103
Type: Publication Only
Background
The pre-analytical and post-analytical phase in a test cycle contributes up to 93% of total laboratory errors. Our coagulation laboratory provides routine and stat tests for inpatients and outpatients in Hacettepe University Hospitals, including 1000 beds. Joint Commission International guidelines is followed in our laboratory; we document the unsuitable samples rejected by laboratory and we record critical value notifications, including the person who received the notification (physician, nurse or medical staff), the time and the date of communication. Hence, rejection of unsuitable samples and critical value notification are the quality indicators of our laboratory.
Aims
In this study, we aimed to evaluate the pre-analytical problems and critical values recorded on coagulation and hemostasis tests over one year period in 2015.
Methods
Venous blood samples for routine coagulation testing were considered unsuitable for analysis according to the following specimen rejection criteria of our laboratory; inappropriate clinical orders, inappropriate volume (inadequate blood to anticoagulant ratio), incorrect tube, clotting, delayed transport and visible hemolysis or fibrin following centrifugation.During day time and night shift, authorized laboratory secretary was responsible for reporting of critical values by telephone communication and reverse reading. The critical values in our laboratory were as follows; prothrombin time/international normalized ratio (PT/INR)>5, activated partial thromboplastin time (aPTT)>100 seconds, fibrinogen<100 mg/dL, factor levels<5% and anti-thrombin III<50%.
Results
Total coagulation test request was 155.945 in one year and 5.090 tubes were rejected according to the rejection criteria of our laboratory. On overall, the more frequent pre-analytical problems could be referred as clotting (38.4%), following inappropriate volume (33.2%), inappropriate clinical orders (7.3%), misidentification (6.5%), hemolysis (6%), incorrect tube (3.8%), fibrin (3.3%) and delayed transport (1.5%), respectively.Among 155.945 tests performed in 2015, we reported 475 critical values, the ratio was 0.3% in total. The critical value notification ratio was 56% for INR, 23% for factor levels, 12.2% for fibrinogen, 5.5% for antithrombin III and 3% for aPTT. The critical value reporting rate was 97-99%, dropped call ratio was approximately 1-3% of all.
Conclusion
We detected an overall specimen rejection rate of 3.2% in coagulation laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 1% and to improve total quality management of the laboratory. Our critical value reporting rate was 97-99%, and clinicians were notified of patients’ life-threatening results within 15 minutes. We believe that rapid notification of abnormal test results has an impact on patient outcomes. This is the first report on the pre-analytical and post-analytical phases of coagulation laboratory in Turkey. To improve patient outcome, each laboratory has to establish its own specimen rejection criterias and reporting policy for critical values.
Session topic: E-poster
Keyword(s): Blood coagulation
Type: Publication Only
Background
The pre-analytical and post-analytical phase in a test cycle contributes up to 93% of total laboratory errors. Our coagulation laboratory provides routine and stat tests for inpatients and outpatients in Hacettepe University Hospitals, including 1000 beds. Joint Commission International guidelines is followed in our laboratory; we document the unsuitable samples rejected by laboratory and we record critical value notifications, including the person who received the notification (physician, nurse or medical staff), the time and the date of communication. Hence, rejection of unsuitable samples and critical value notification are the quality indicators of our laboratory.
Aims
In this study, we aimed to evaluate the pre-analytical problems and critical values recorded on coagulation and hemostasis tests over one year period in 2015.
Methods
Venous blood samples for routine coagulation testing were considered unsuitable for analysis according to the following specimen rejection criteria of our laboratory; inappropriate clinical orders, inappropriate volume (inadequate blood to anticoagulant ratio), incorrect tube, clotting, delayed transport and visible hemolysis or fibrin following centrifugation.During day time and night shift, authorized laboratory secretary was responsible for reporting of critical values by telephone communication and reverse reading. The critical values in our laboratory were as follows; prothrombin time/international normalized ratio (PT/INR)>5, activated partial thromboplastin time (aPTT)>100 seconds, fibrinogen<100 mg/dL, factor levels<5% and anti-thrombin III<50%.
Results
Total coagulation test request was 155.945 in one year and 5.090 tubes were rejected according to the rejection criteria of our laboratory. On overall, the more frequent pre-analytical problems could be referred as clotting (38.4%), following inappropriate volume (33.2%), inappropriate clinical orders (7.3%), misidentification (6.5%), hemolysis (6%), incorrect tube (3.8%), fibrin (3.3%) and delayed transport (1.5%), respectively.Among 155.945 tests performed in 2015, we reported 475 critical values, the ratio was 0.3% in total. The critical value notification ratio was 56% for INR, 23% for factor levels, 12.2% for fibrinogen, 5.5% for antithrombin III and 3% for aPTT. The critical value reporting rate was 97-99%, dropped call ratio was approximately 1-3% of all.
Conclusion
We detected an overall specimen rejection rate of 3.2% in coagulation laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 1% and to improve total quality management of the laboratory. Our critical value reporting rate was 97-99%, and clinicians were notified of patients’ life-threatening results within 15 minutes. We believe that rapid notification of abnormal test results has an impact on patient outcomes. This is the first report on the pre-analytical and post-analytical phases of coagulation laboratory in Turkey. To improve patient outcome, each laboratory has to establish its own specimen rejection criterias and reporting policy for critical values.
Session topic: E-poster
Keyword(s): Blood coagulation
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