Preanalytical errors in hospitals Implications for quality improvement of blood sample collection

...........................................................................................1 LIST OF ABBREVIATIONS .....................................................................2 ORIGINAL ARTICLES.............................................................................3 PROLOGUE ...........................................................................................4 BACKGROUND......................................................................................5 Introduction ........................................................................................5 Medical errors ....................................................................................5 The total testing process ....................................................................6 Venous blood samples..................................................................8 Preanalytical errors.............................................................................9 Patient identification and test tube labelling................................ 10 Sample collection ....................................................................... 11 Test requests .............................................................................. 11 Transport of blood samples ........................................................ 12 Analytical and postanalytical errors .................................................. 13 Sources of preanalytical information ................................................ 13 Error reporting .................................................................................. 15 Quality improvement ........................................................................ 16 International context for sample collection ....................................... 17 RATIONALE ......................................................................................... 18 AIMS .................................................................................................... 19 The questionnaire study ................................................................... 19 The experimental study .................................................................... 19 METHODS ........................................................................................... 21 The questionnaire study ................................................................... 21 Design and setting ...................................................................... 21 Participants................................................................................. 22 Development procedure for the questionnaire ............................ 23 Procedure for data collection...................................................... 25 Statistical analysis....................................................................... 26 Ethical considerations ................................................................. 26 The experimental study .................................................................... 27 Subjects and sample collection .................................................. 27 Sample transport and analysis.................................................... 27 Statistical analysis....................................................................... 28 Ethical considerations ................................................................. 28 CONSIDERATIONS.............................................................................. 29 The questionnaire study ................................................................... 29 Study design............................................................................... 29 Data collection ............................................................................ 29 Internal validity ............................................................................ 30 Reliability .................................................................................... 31 External validity........................................................................... 31 Statistical analysis....................................................................... 32 The experimental study .................................................................... 32 RESULTS AND DISCUSSION .............................................................. 33 Patient identification and test tube labelling ..................................... 33 Test request management................................................................ 35 Information search procedures......................................................... 37 Patient rest, stasis removal and test tube handling .......................... 38 Education and routines in the wards ................................................ 38 Hospital, type of ward and frequency of VBS................................... 39 Differences between the wards and the laboratories........................ 40 Aspects on VBS staff in Sweden ...................................................... 40 Error reporting practices................................................................... 41 Pneumatic tube transport ................................................................. 42 IMPLICATIONS FOR QUALITY IMPROVEMENT .................................. 45 FUTURE RESEARCH ........................................................................... 48 CONCLUSIONS ................................................................................... 49 EPILOGUE ........................................................................................... 50 POPULÄRVETENSKAPLIG SAMMANFATTNING................................. 51 ACKNOWLEDGEMENTS ..................................................................... 53 REFERENCES...................................................................................... 55