Le Rachel D, Melanson Stacy E F, Petrides Athena K, Goonan Ellen M, Bixho Ida, Landman Adam B, Brogan Anne Marie, Bates David W, Tanasijevic Milenko J
From the University of Massachusetts Medical School, Worcester, MA.
Department of Pathology Harvard Medical School, Boston, MA.
Am J Clin Pathol. 2016 Oct;146(4):456-61. doi: 10.1093/ajcp/aqw139.
Most preanalytical errors at our institution occur during nonphlebotomy blood draws. We implemented an electronic health record (EHR), interfaced the EHR to the laboratory information system, and designed a new specimen collection module. We studied the effects of the new system on nonphlebotomy preanalytical errors.
We used an electronic database of preanalytical errors and calculated the number and type of the most common errors in the emergency department (ED) and inpatient nursing for 3-month periods before (August-October 2014) and after (August-October 2015) implementation. The level of staff compliance with the new system was also assessed.
The average monthly preanalytical errors decreased significantly from 7.95 to 1.45 per 1,000 specimens in the ED (P < 0001) and 11.75 to 3.25 per 1,000 specimens in inpatient nursing (P < 0001). The rate of decrease was similar for mislabeled, unlabeled, wrong specimen received and no specimen received errors. Most residual errors (80% in the ED and 67% in inpatient nursing) occurred when providers did not use the new system as designed.
Implementation of a customized specimen collection module led to a significant reduction in preanalytical errors. Improved compliance with the system may lead to further reductions in error rates.
我们机构的大多数分析前误差发生在非静脉穿刺采血过程中。我们实施了电子健康记录（EHR），将EHR与实验室信息系统连接，并设计了一个新的标本采集模块。我们研究了新系统对非静脉穿刺分析前误差的影响。
我们使用了一个分析前误差的电子数据库，计算了实施前（2014年8月至10月）和实施后（2015年8月至10月）急诊科（ED）和住院护理中3个月期间最常见误差的数量和类型。还评估了工作人员对新系统的遵守程度。
急诊科每1000个标本的平均每月分析前误差从7.95显著降至1.45（P < 0.0001），住院护理中从每1000个标本的11.75降至3.25（P < 0.0001）。标签错误、未贴标签、接收错误标本和未接收标本的误差下降率相似。大多数残留误差（急诊科为80%，住院护理中为67%）发生在提供者未按设计使用新系统时。
定制标本采集模块的实施导致分析前误差显著减少。提高对系统的遵守程度可能会进一步降低错误率。
