Avoiding specimen transportation errors.

he increasing trend toward ambulatory care, home healthcare, nursing home care, and other alternate sites, has created variations in laboratory services and increased probability of medical errors. As an example, in order to increase laboratory volume, laboratory administrators have had to redirect blood collection services to outlying home and clinic settings via contracts with various physicians’ clinics and home healthcare agencies. In addition, many hospital phlebotomists have had their positions changed into courier blood collectors who must travel several miles a day, in sometimes inclement weather conditions, to collect blood specimens from home and ambulatory clinic settings. These specimens then must be transported to the core laboratory for testing. All of these variations in specimen collection and transportation add to the likelihood of increased errors in laboratory testing. Of laboratory errors, 46 percent to 68 percent occur in the preanalytical phase rather than the analytical and postanalytical phases (10 percent to 20 percent).1,2 However, many laboratory and healthcare personnel overlook the impact that the preanalytical specimen collection phase has in medical errors, especially in the transport of specimens. As an example, specimen transportation is an area in which requirements were not established in the Clinical Laboratory Improvements Amendments of 1988. With the variations in these ambulatory and home specimen collections and transportation, a high probability exists for overlooking safety policies for specimen handling and transportation in off-site blood collections. Important questions are: What are the liability issues regarding the use of phlebotomists T as specimen couriers? How should risk management be handled for specimen collection and handling?