Outpatient phlebotomy success and reasons for specimen rejection.
OBJECTIVE
To determine the rate with which blood collection is successful on the initial phlebotomy encounter, the rate with which laboratory personnel judge specimens unsuitable for analysis, and the practice characteristics associated with fewer unsuccessful collections and fewer rejected specimens.


METHODS
Clinical laboratories participating in the College of American Pathologists Q-Probes laboratory improvement program prospectively characterized the outcome of outpatient phlebotomies for 3 months or until 20 unsuccessful phlebotomy encounters occurred. By questionnaire, participants provided information about test ordering, patient preparation, and specimen collection.


METHODS
Institutions in the United States (n = 202), Canada (n = 4), Australia (n = 3), and South Korea (n = 1).


METHODS
Percentage of successful encounters and percentage of unsuitable specimens.


RESULTS
Of 833289 encounters, 829723 were successful. Phlebotomies were unsuccessful because patients were not fasting as directed (32.2%), phlebotomy orders were missing information (22.5%), patients specimens were difficult to draw (13.0%), patients left the collection area before specimens were collected (11.8%), patients were improperly prepared for reasons other than fasting (6.3%), patients presented at the wrong time (3.1%), or for other reasons (11.8%). Only 2153 specimens (0.3%) were unsuitable; these samples were hemolyzed (18.1%), of insufficient quantity (16.0%), clotted (13.4%), lost or not received in the laboratory (11.5%), inadequately labeled (5.8%), at variance with previous or expected results (4.8%), or unacceptable for other reasons (31.1%). Facilities staffed by laboratory-administered phlebotomists reported higher success rates than facilities staffed by nonlaboratory-administered phlebotomists (P =.002).


CONCLUSIONS
Most outpatient phlebotomy encounters are successful and result in specimens suitable for laboratory analysis.
Dale
Jane C
JC
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. dale.jane@mayo.edu
Novis
David A
DA
D001315:Australia; D001800:Blood Specimen Collection / Q000592:standards*; D002170:Canada; D006801:Humans; D015337:Multicenter Studies as Topic; D010338:Pathology, Clinical / Q000592:standards*; D018962:Phlebotomy / Q000592:standards*; D011446:Prospective Studies; D011786:Quality Control; D012955:Societies, Medical; D014481:United States