Recording, monitoring and managing preanalytical issues in a metropolitan university hospital

adverse impacts on patient safety and care. The pre-analytical phase is responsible for ~70% of these errors. In this study we present the experience in assessing the frequency of the most common pre-analytical issues in our university hospital by monitoring their trend over time and comparing, when possible,data with goals suggested in literature. The impact of corrective actions, if any, was also checked. Methods: A comprehensive retrospective analysis of the preanalytical nonconformities (NC) recorded through laboratory information system over a 5-year (2007-2011) time span was undertaken. Retrieved data were evaluated on a yearly basis for NC type and then for type of sample and for involved laboratory section and hospital department. Results: The relatively most frequent NC was the test request without the corresponding sample, accounting on average for 2.3% of all requested tests. Hemolysis occurred in 1.15% (mean value over 5 years) of requested tests, affecting ~20,000 determinations per year, mostly interesting clinical wards taking care of critically ill patients, i.e. neonatology, oncology and emergency department. Clotted and not sufficient samples showed a significant reduction over time, induced by the change of the analytical system measuring erythrocyte sedimentation rate and the corresponding replacement of sodium citrate rectangular tubes by more reliable K3EDTA round tubes, easier to fill in and mix cup. NC related to samples conveyed at wrong temperature, both for tests requiring transportation in ice bath (i.e. ammonium) or at 37 °C temperature (i.e. cryoglobulins), were also relative frequent. Conclusions: Our results show that recording, monitoring and critically evaluating pre-analytical issues in laboratory testing process is mandatory for providing a good laboratory service, permitting to identify the causes of NC and to apply corrective interventions that may help to reduce their incidence.