Classification of reasons for rejection of biological specimens based on pre-preanalytical processes to identify quality indicators at a university hospital clinical laboratory in Turkey

Objectives

Specific types of error should be identified and corrected in each laboratory to ensure quality results. The objectives of this study were:

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to identify and classify the causes of biological specimen rejections,

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to determine the specimen rejection rates (SRRs) in terms of pre-preanalytical errors and with respect to collection areas, and

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to identify an appropriate quality indicator (QI) for the preanalytical phase in a university hospital clinical laboratory.

Design and methods

Data on rejected biological specimens in the laboratory information system from January 2013 to January 2014 were analyzed. SSRs according to the type of pre-preanalytical error and collection area were determined.

Results

In total, 971,780 biological specimens were received during the period and 26,070 (2.7%) specimens were rejected based on our laboratory rejection criteria. The most frequent reason for the rejection was the clotted specimen (55.8% of total rejections), followed by inadequate volume (29.3% of total rejections). Most of the clotted specimens were received from adult hospital inpatient services (54.3%), followed by pediatric hospital inpatient services (26.8%). High rates of inadequate volume were also observed in samples originating from adult and pediatric hospital inpatient services, especially in the premature, neonatal, intensive care, and oncology units.

Conclusions

The SSR of clotted specimens was selected as the QI for the preanalytical phase in our laboratory. The selected QI will help to define the effects of our specific interventions and corrective actions, and thus allow monitoring of quality improvement in our hospitals.