title: Causes and impact of specimen rejection in a clinical chemistry laboratory.
abstract: BACKGROUND
  Pre-analytical errors necessitate specimen rejection and negatively affect patient safety. Our purpose was to investigate the factors leading to specimen rejection and its impact.
  
  
  METHODS
  Specimen rejections in a clinical chemistry laboratory during a 1-year period were reviewed retrospectively and analyzed for frequency, cause, circumstances, and impact.
  
  
  RESULTS
  Of the 837,862 specimens received, 2178 (0.26%) were rejected. The most common reasons for specimen rejection were contamination (n=764, 35.1%), inappropriate collection container/tube (n=330, 15.2%), quantity not sufficient (QNS) (n=329, 15.1%), labeling errors (n=321, 14.7%), hemolyzed specimen (n=205, 9.4%), and clotted specimen (n=203, 9.3%). The analytes most often affected were glucose (n=192, 8.8%); calcium (n=152, 7.0%), magnesium (n=148, 6.8%), potassium (n=137, 6.3%), creatinine (n=100, 4.6%), and blood urea nitrogen (n=97, 4.4%). Outpatient service and blood draw by phlebotomists were associated with low rejection rates (536/493,501 or 0.11% and 368/586,503 or 0.06%, respectively). Recollection due to specimen rejection increased the turnaround time by an average of 108min. The total cost for the recollection was around $43,210 USD with an average cost around $21.9 USD.
  
  
  CONCLUSIONS
  The factors associated with rejection are remediable by improved training and quality assurance measures. Policies and procedures specific to specimen collection, transportation, and preparation should be strictly followed.
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Liyun
authors.initials: L
authors.lastname: Cao
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Meng
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Ron A
authors.initials: RA
authors.lastname: Phipps
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Del Guidice
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Beverly C
authors.initials: BC
authors.lastname: Handy
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wagar
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States. Electronic address: qhmeng@mdanderson.org.
authors.forename: Qing H
authors.initials: QH
authors.lastname: Meng
mesh_terms: D001800:Blood Specimen Collection / Q000379:methods* / Q000592:standards*; D001806:Blood Urea Nitrogen; D002118:Calcium / Q000097:blood; D002624:Chemistry, Clinical; D019411:Clinical Laboratory Techniques / Q000379:methods* / Q000592:standards; D003404:Creatinine / Q000097:blood; D005947:Glucose / Q000032:analysis; D006801:Humans; D008274:Magnesium / Q000097:blood; D011188:Potassium / Q000097:blood; D011786:Quality Control; D012189:Retrospective Studies
chemical_list: D003404:Creatinine; D008274:Magnesium; D005947:Glucose; D011188:Potassium; D002118:Calcium
keywords: Clinical chemistry; Pre-analytical error; Specimen rejection