Phlebotomy issues and quality improvement in results of laboratory testing.
Laboratory testing is an integral part of the decision-making process, and results of laboratory testing often strongly influence medical diagnoses and therapies. There is a long history of quality requirements in laboratory medicine, which have mainly concerned the analytic phase of this process. Owing to the substantial advances in technology, laboratory automation and analytic quality, there is increasing evidence that further quality improvements should be targeted to extra-analytic phases of laboratory testing. Objective difficulties to monitor most of the preanalytic variables which lie outside the direct control or supervision of the laboratory personnel, such as phlebotomy, call for effective educational and preventive policies. Owing to high personnel turnover rates, lack of understanding about good laboratory practices, and inadequate training, there are several opportunities for making errors during phlebotomy, which mainly concern patient misidentification and collection of unsuitable specimens for testing due to unsuited venous accesses, venous stasis, inappropriate collection devices and containers. Improved standardization of phlebotomy techniques, along with operative guidelines dissemination, continuous education, certification, and training of health care professionals involved in blood drawing responsibilities would enhance the chance of obtaining specimens of consistent quality, with favorable revenues for the health care system and the patient's outcome.
Lippi
Giuseppe
G
Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy. ulippi@tin.it
Salvagno
Gian Luca
GL
Montagnana
Martina
M
Franchini
Massimo
M
Guidi
Gian Cesare
GC
D001815:Bloodletting / Q000266:history; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D017056:Medical Laboratory Personnel / Q000193:education / Q000592:standards; D010355:Patient Identification Systems; D018962:Phlebotomy / Q000266:history / Q000379:methods / Q000592:standards*; D011786:Quality Control