title: Clinical consequences of specimen rejection: a College of American Pathologists Q-Probes analysis of 78 clinical laboratories.
abstract: BACKGROUND
  Clinical laboratory specimens may be rejected as unsuitable for analysis for a variety of reasons and specimen rejection may have significant clinical consequences.
  
  
  OBJECTIVE
  To quantify the clinical consequences of specimen rejection and determine the impact of laboratories' policies and practices on these consequences.
  
  
  METHODS
  Participants prospectively reviewed consecutive blood and urine specimens submitted to the chemistry and/or hematology laboratories to identify rejected specimens. For each rejected specimen, the patient's age, specimen type, testing priority, rejection reason, time from specimen receipt to receipt of recollected/relabeled specimen, recollection method, and test result time were recorded. Specimen/test abandonment was determined by failure to recollect or relabel a rejected specimen. Each laboratory's policy regarding relabeling of incorrectly labeled specimens was recorded, along with how many relabeled specimens were subsequently discovered to be mislabeled.
  
  
  RESULTS
  Specimen rejection led to a (1) high rate of specimen recollection, (2) delay in result availability (median of 65 minutes), and (3) high rate of specimen/test abandonment. Longer test result delay was associated with higher hospital bed size; and higher test abandonment rate, with failure of the laboratory to request specimen recollection. Relabeling of incorrectly labeled specimens was found to be of little benefit and was associated with a substantial percentage of subsequently mislabeled specimens.
  
  
  CONCLUSIONS
  Specimen rejection has significant clinical consequences, including patient discomfort, significant delay in result availability, and high rate of specimen/test abandonment. Allowing routine relabeling of incorrectly labeled specimens is a dangerous practice, with little measureable benefit and with an increased risk to patient safety.
authors: From the Department of Pathology, The George Washington University Medical Center, Washington, DC (Dr Karcher); and the Department of Pathology, University of Utah School of Medicine, Salt Lake City (Dr Lehman).
authors: Donald S
authors: DS
authors: Karcher
authors: Christopher M
authors: CM
authors: Lehman
mesh_terms: D001774:Blood Chemical Analysis / Q000592:standards*; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards; D059021:Laboratory Proficiency Testing; D019300:Medical Errors / Q000517:prevention & control*; D010336:Pathology / Q000379:methods; D011446:Prospective Studies; D058996:Quality Improvement; D012955:Societies, Medical; D013048:Specimen Handling; D009626:Terminology as Topic; D013997:Time Factors; D014481:United States; D016482:Urinalysis / Q000592:standards*