title: Specimen rejection in laboratory medicine: Necessary for patient safety?
abstract: BACKGROUND
  The emergency laboratory in Hacettepe University Hospitals receives specimens from emergency departments (EDs), inpatient services and intensive care units (ICUs). The samples are accepted according to the rejection criteria of the laboratory. In this study, we aimed to evaluate the sample rejection ratios according to the types of pre-preanalytical errors and collection areas.
  
  
  METHODS
  The samples sent to the emergency laboratory were recorded during 12 months between January to December, 2013 in which 453,171 samples were received and 27,067 specimens were rejected.
  
  
  RESULTS
  Rejection ratios was 2.5% for biochemistry tests, 3.2% for complete blood count (CBC), 9.8% for blood gases, 9.2% for urine analysis, 13.3% for coagulation tests, 12.8% for therapeutic drug monitoring, 3.5% for cardiac markers and 12% for hormone tests. The most frequent rejection reasons were fibrin clots (28%) and inadequate volume (9%) for biochemical tests. Clotted samples (35%) and inadequate volume (13%) were the major causes for coagulation tests, blood gas analyses and CBC. The ratio of rejected specimens was higher in the EDs (40%) compared to ICUs (30%) and inpatient services (28%). The highest rejection ratio was observed in neurology ICU (14%) among the ICUs and internal medicine inpatient service (10%) within inpatient clinics.
  
  
  CONCLUSIONS
  We detected an overall specimen rejection rate of 6% in emergency laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 2%, improve total quality management of the emergency laboratory and promote patient safety.
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Medical Biochemistry and Hacettepe University Hospitals, Clinical Pathology Laboratory, Ankara, Turkey.
authors.forename: Zeliha Gunnur
authors.initials: ZG
authors.lastname: Dikmen
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Medical Biochemistry and Hacettepe University Hospitals, Clinical Pathology Laboratory, Ankara, Turkey.
authors.forename: Asli
authors.initials: A
authors.lastname: Pinar
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Medical Biochemistry and Hacettepe University Hospitals, Clinical Pathology Laboratory, Ankara, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Akbiyik
mesh_terms: D001774:Blood Chemical Analysis / Q000592:standards / Q000706:statistics & numerical data; D001800:Blood Specimen Collection / Q000592:standards; D019411:Clinical Laboratory Techniques / Q000592:standards* / Q000706:statistics & numerical data; D016903:Drug Monitoring / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D006748:Hospital Departments / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D019300:Medical Errors / Q000517:prevention & control; D061214:Patient Safety / Q000592:standards; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D013048:Specimen Handling / Q000592:standards*; D017749:Total Quality Management; D014421:Turkey; D016482:Urinalysis / Q000592:standards / Q000706:statistics & numerical data
keywords: clinical laboratory services; patient safety; preanalytical error; preanalytical phase; total quality management