title: Clinical laboratory specimen rejection--association with the site of patient care and patients' characteristics: findings from a single health care organization.
abstract: BACKGROUND
  Programs to track laboratory quality have reported aggregated specimen rejection rates ranging from 0.30% to 0.83%. Because the performance of the laboratory, rather than errors, has been the focus, reasons for specimen rejection or demographic characteristics of individuals at risk for specimens of poor quality may not be fully understood.
  
  
  OBJECTIVE
  To calculate the proportions of rejected specimens stratified by point of collections and demographic information of patients.
  
  
  METHODS
  Retrospective cross-sectional study. Data were retrieved from the intrainstitutional electronic databases.
  
  
  RESULTS
  The proportions of specimens that were rejected in the emergency department and inpatient services were 2-fold and more than 5-fold higher, respectively, than for the outpatient services. Assessment of data by patients' ethnic heritages yielded no significant differences among African Americans (0.38%), Caucasians (0.38%), or "Others" (0.35%) in the outpatient services (P = .07). In the emergency department, the proportions of rejected specimens for African Americans (2.24%) were almost twice that of Caucasians (1.39%) and 30% higher than for Others (1.70%). A similar finding was observed for the inpatient services.
  
  
  CONCLUSIONS
  The effect of ethnicity on the proportions of rejected specimens was significant for samples that were collected in the emergency department and inpatient services, even after adjusting for the total number of specimens. A constellation of factors, that is, disease severity and seriousness, practice of blood sample collection, and lesser proficiency of the nursing staff in phlebotomy may be reasons for this observation. However, the likelihood of differential care, although unlikely, cannot be refuted by the present data.
authors.affiliation: Department of Pathology and Laboratory Medicine, K-6, Henry Ford Health System Main Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA. astark1@hfhs.org
authors.forename: Azadeh
authors.initials: A
authors.lastname: Stark
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Jones
authors.forename: Deborah
authors.initials: D
authors.lastname: Chapman
authors.forename: Karen
authors.initials: K
authors.lastname: Well
authors.forename: Richard
authors.initials: R
authors.lastname: Krajenta
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Meier
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Zarbo
mesh_terms: D001800:Blood Specimen Collection / Q000592:standards*; D003430:Cross-Sectional Studies; D003710:Demography; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*; D011786:Quality Control; D012189:Retrospective Studies; D013048:Specimen Handling / Q000592:standards*; D013997:Time Factors