Systematic assessment of culture review as a tool to assess errors in the clinical microbiology laboratory.
BACKGROUND
Daily supervisory review is a common practice in microbiology laboratories; however, there are no publications describing errors corrected by this practice.


OBJECTIVE
To determine (1) the correction rates for routinely reviewed positive cultures, (2) the correction rates for negative cultures, and (3) the types of corrections that are found, including the number with potential clinical significance.


METHODS
We prospectively assessed errors identified during culture report review for all positive (10-month period) and negative (1-month period) cultures at a single, university-based clinical microbiology laboratory in the United States. Errors were classified using predefined categories, and total and per category error rates were determined. A chi(2) test was used to assess significant differences between error rates.


RESULTS
A total of 112,108 culture reports were examined; 914 reports required a total of 1043 corrections. Of 101,703 positive culture reports, 786 (0.8%) required 900 corrections, 302 (0.3%) of which were potentially clinically significant. Of 10,405 negative culture reports, 128 (1.2%) required 143 corrections, 5 (0.05%) of which were potentially clinically significant. The rate of potentially clinically significant errors was significantly higher among positive versus negative culture reports (P < .001). Errors from positive culture reports most commonly involved susceptibility (374 [42%]), reporting (275 [31%]), and identification workup (217 [24%]). Most potentially significant errors from positive culture reports involved susceptibility testing (n = 253) and specimens from wound or lower respiratory tract (P < .001).


CONCLUSIONS
Review of culture reports from positive cultures from nonsterile sites with special attention to antimicrobial susceptibility testing and reporting would be most likely to detect potentially significant errors within the clinical microbiology laboratory.
Goodyear
Nancy
N
Department of Laboratory Medicine, University of Washington, Box 357110, Seattle, WA 98195, USA. limaye@u.washington.edu
Ulness
Bruce K
BK
Prentice
Jennifer L
JL
Cookson
Brad T
BT
Limaye
Ajit P
AP
D016009:Chi-Square Distribution; D019411:Clinical Laboratory Techniques / Q000592:standards*; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D006801:Humans; D008828:Microbiological Techniques / Q000379:methods* / Q000592:standards*; D011446:Prospective Studies; D012955:Societies, Medical; D014481:United States