Division of Chemical Pathology, National Health Laboratory Services and University of Stellenbosch, Tygerberg Hospital, Western Cape, South Africa.
J Clin Pathol. 2010 May;63(5):434-7. doi: 10.1136/jcp.2009.072058. Epub 2010 Mar 18.
Laboratory errors made during the pre-analytical phase can have an impact on clinical care. Quality management tools such as Six Sigma may help improve error rates.
To use elements of a Six Sigma model to establish the error rate of test registration onto the laboratory information system (LIS), and to deduce the potential clinical impact of these errors.
In this retrospective study, test request forms were compared with the tests registered onto the LIS, and all errors were noted before being rectified. The error rate was calculated. The corresponding patient records were then examined to determine the actual outcome, and to deduce the potential clinical impact of the registration errors.
Of the 47 543 tests requested, 72 errors were noted, resulting in an error rate of 0.151%, equating to a sigma score of 4.46. The patient records reviewed indicated that these errors could, in various ways, have impacted on clinical care.
This study highlights the clinical effect of errors made during the pre-analytical phase of the laboratory testing process. Reduction of errors may be achieved through implementation of a Six Sigma programme.
分析前阶段的实验室错误可能会对临床护理产生影响。质量管理工具，如六西格玛，可能有助于降低错误率。
运用六西格玛模型的要素来确定实验室信息系统（LIS）上测试注册的错误率，并推断这些错误的潜在临床影响。
在这项回顾性研究中，将检验申请单与 LIS 上注册的检验进行比较，并在纠正之前记录所有错误。计算错误率。然后检查相应的患者记录，以确定实际结果，并推断注册错误的潜在临床影响。
在所请求的 47543 次检验中，发现了 72 个错误，错误率为 0.151%，相当于西格玛分数为 4.46。审查的患者记录表明，这些错误可能以各种方式影响临床护理。
本研究强调了实验室检测过程分析前阶段错误的临床影响。通过实施六西格玛计划，可以减少错误。
