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Occurrence rates in pre-analytic laboratory processes in a large tertiary
care academic hospitalitle
Lucia M. Berte, Quality Systems Consultant, Westminster, Colorado
An occurrence reporting process was initiated as part of quality system
implementation in a department of laboratory medicine and pathology that serves
a 700 bed tertiary care teaching hospital in North America. Occurrences -- i.e., events found to be
nonconforming with laboratory requirements -- were tabulated for the specimen control area,
which is staffed by approximately 100 laboratory assistants who are
cross-trained in specimen collection, test order entry, specimen accessioning,
and specimen processing. To measure the effect of installing an automated
system for centrifugation, aliquotting and specimen sorting, baseline numbers
of occurrences were tabulated for the specimen control area. For the last 6
months of 2002, approximately 400,000 specimens were processed with 1310
preanalytic occurrences documented; the occurrence rate is 3.3 per thousand
specimens. A world-class quality rate is considered to be 3 defects per
million opportunities, hence the laboratorys rate of 3300 occurrences per
million (pm) represents considerable internal failure cost. The Table shows the
frequency and occurrence rate for individual processes in the pre-analytic
portion of the test ordering cycle.
| Preanalytic Process
|
Occurrences (N)
|
Per Thousand
|
Per Million |
|
| Test ordering
|
98 |
0.2 |
245 |
| Blood drawing
|
389 |
0.9
|
972 |
| Specimen transport
|
13 |
0.03 |
32 |
| Order entry
|
324 |
0.8 |
810 |
| Processing, labeling
|
104 |
0.2 |
260 |
| Missing/ misdirected specimens
|
382 |
0.9 |
955 |
|
| Total
|
1310 |
|
3274 |
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