基层医疗患者样本的分析前错误。

Preanalytical mistakes in samples from primary care patients.

机构信息

Clinical Laboratory, University Hospital Virgen de la Victoria, Málaga, Spain.

出版信息

Clin Chem Lab Med. 2009;47(12):1549-52. doi: 10.1515/CCLM.2009.338.

DOI:10.1515/CCLM.2009.338

PMID:19929554

Abstract

BACKGROUND

Preanalytical mistakes (PAMs) in samples usually led to rejection upon arrival to the clinical laboratory. However, PAMs might not always be detected and result in clinical problems. Thus, PAMs should be minimized. We detected PAMs in samples from Primary Health Care Centres (PHCC) served by our central laboratory. Thus, the goal of this study was to describe the number and types of PAMs, and to suggest some strategies for improvement.

METHODS

The presence of PAMs, as sample rejection criteria, in samples submitted from PHCC to our laboratory during October and November 2007 was retrospectively analysed.

RESULTS

Overall, 3885 PAMs (7.4%) were detected from 52,669 samples for blood analyses. This included missed samples (n=1763; 45.4% of all PAMs, 3.3% of all samples), haemolysed samples (n=1408; 36.2% and 2.7%, respectively), coagulated samples (n=391; 10% and 0.7%, respectively), incorrect sample volume (n=110; 2.8% and 0.2%, respectively), and others (n=213; 5.5% and 0.4%, respectively). For urine samples (n=18,852), 1567 of the samples were missing (8.3%).

CONCLUSIONS

We found the proportion of PAMs in blood and urine samples to be 3-fold higher than that reported in the literature. Therefore, strategies for improvement directed towards the staff involved, as well as an exhaustive audit of preanalytical process are needed. To attain this goal, we first implemented a continued education programme, financed by our Regional Health Service and focused in Primary Care Nurses.

摘要

背景

样本的分析前错误（PAMs）通常会导致样本在到达临床实验室时被拒收。然而，PAMs 并不总是能够被检测到，从而导致临床问题。因此，应尽量减少 PAMs 的发生。我们检测了由我们的中心实验室服务的基层医疗保健中心（PHCC）送来的样本中的 PAMs。因此，本研究的目的是描述 PAMs 的数量和类型，并提出一些改进策略。

方法

回顾性分析了 2007 年 10 月和 11 月期间，从 PHCC 送到我们实验室的样本中 PAMs 作为样本拒收标准的存在情况。

结果

总体而言，在 52669 个血液分析样本中发现了 3885 个 PAMs（7.4%）。这包括漏检样本（n=1763；占所有 PAMs 的 45.4%，所有样本的 3.3%）、溶血样本（n=1408；占所有 PAMs 的 36.2%，占所有样本的 2.7%）、凝固样本（n=391；占所有 PAMs 的 10%，占所有样本的 0.7%）、样本量不正确（n=110；占所有 PAMs 的 2.8%，占所有样本的 0.2%）和其他（n=213；占所有 PAMs 的 5.5%，占所有样本的 0.4%）。对于尿液样本（n=18852），有 1567 个样本缺失（8.3%）。