Jt Comm J Qual Patient Saf. 2021 Aug;47(8):519-525. doi: 10.1016/j.jcjq.2021.04.005. Epub 2021 May 19.
Clinical laboratories play a vital role in patient diagnosis and management. However, blood specimens may be rejected for a variety of reasons, which may have substantial clinical consequences for patient safety. The quality team observed significant numbers of rejected samples from the emergency department and inpatient units due to hemolysis. A total of 1.43% of the blood samples were rejected, which was considerably higher than the target of 0.4%.
This project aimed to reduce the percentage of rejected blood samples from 1.43% (measured between January 2015 and April 2016) by 50% in the emergency department and the coronary ICU by December 2017. The team identified preanalytical errors as the primary reason for rejections. A multidisciplinary team was formed and tested several changes, including phlebotomy education, competency validation by direct observations, the use of appropriate consumables for sampling, and physician education for proper orders.. All specimens sent for blood chemistry, arterial blood gas analysis, hematology, and coagulation tests were included. Microbiology test specimens and point-of-care testing samples were excluded.
The percentage of rejected blood samples dropped from 1.43% (January 2015-April 2016) to 0.47% in 2018, which was a statistically significant reduction (p < 0.001).
Using a quality improvement approach for the detailed analyses of specimen rejection rates and related issues helped to formulate efficient plans to target this issue. Weekly rapid cycle improvements from January 2018 helped to achieve the team's goals quickly and had a major impact in combination with other interventions.
临床实验室在患者诊断和管理中起着至关重要的作用。然而，由于各种原因，血液标本可能会被拒收，这可能对患者安全产生重大的临床后果。质量团队观察到由于溶血，来自急诊部和住院部的大量拒收标本。总的来说，有 1.43%的血液样本被拒收，这明显高于 0.4%的目标。
本项目旨在将急诊部和冠心病监护病房（coronary ICU）拒收血液样本的百分比从 1.43%（2015 年 1 月至 2016 年 4 月）降低 50%，至 2017 年 12 月。团队确定分析前误差是拒收的主要原因。成立了一个多学科团队，并测试了几种改变，包括采血教育、通过直接观察验证能力、使用适当的采样耗材、以及为正确医嘱对医生进行教育。所有送血化学、动脉血气分析、血液学和凝血检测的标本均包括在内。微生物测试标本和即时检测样本除外。
拒收血液样本的百分比从 1.43%（2015 年 1 月至 2016 年 4 月）降至 2018 年的 0.47%，这是一个统计学上显著的降低（p<0.001）。
使用质量改进方法对标本拒收率及相关问题进行详细分析，有助于制定有针对性的解决方案。自 2018 年 1 月开始的每周快速循环改进，结合其他干预措施，帮助团队迅速实现了目标，并产生了重大影响。
