title: Preanalytical quality improvement: from dream to reality.
abstract: Abstract Laboratory diagnostics (i.e., the total testing process) develops conventionally through a virtual loop, originally referred to as "the brain to brain cycle" by George Lundberg. Throughout this complex cycle, there is an inherent possibility that a mistake might occur. According to reliable data, preanalytical errors still account for nearly 60%-70% of all problems occurring in laboratory diagnostics, most of them attributable to mishandling procedures during collection, handling, preparing or storing the specimens. Although most of these would be "intercepted" before inappropriate reactions are taken, in nearly one fifth of the cases they can produce inappropriate investigations and unjustifiable increase in costs, while generating inappropriate clinical decisions and causing some unfortunate circumstances. Several steps have already been undertaken to increase awareness and establish a governance of this frequently overlooked aspect of the total testing process. Standardization and monitoring preanalytical variables is of foremost importance and is associated with the most efficient and well-organized laboratories, resulting in reduced operational costs and increased revenues. As such, this article is aimed at providing readers with significant updates on the total quality management of the preanalytical phase to endeavour further improvement for patient safety throughout this phase of the total testing process.
authors.affiliation: Clinical Chemistry and Hematology Laboratory, Academic Hospital of Parma, Parma, Italy. glippi@ao.pr.it; ulippi@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Chance
authors.forename: Stephen
authors.initials: S
authors.lastname: Church
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzi
authors.forename: Rossana
authors.initials: R
authors.lastname: Fontana
authors.forename: Davide
authors.initials: D
authors.lastname: Giavarina
authors.forename: Kjell
authors.initials: K
authors.lastname: Grankvist
authors.forename: Wim
authors.initials: W
authors.lastname: Huisman
authors.forename: Timo
authors.initials: T
authors.lastname: Kouri
authors.forename: Vladimir
authors.initials: V
authors.lastname: Palicka
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Puro
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Salvagno
authors.forename: Sverre
authors.initials: S
authors.lastname: Sandberg
authors.forename: Ken
authors.initials: K
authors.lastname: Sikaris
authors.forename: Ian
authors.initials: I
authors.lastname: Watson
authors.forename: Ana K
authors.initials: AK
authors.lastname: Stankovic
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Simundic
mesh_terms: D019411:Clinical Laboratory Techniques / Q000379:methods* / Q000592:standards*; D003951:Diagnostic Errors; D006801:Humans; D010355:Patient Identification Systems; D019095:Point-of-Care Systems; D011786:Quality Control; D013048:Specimen Handling