title: Targeting Rejection: Analysis of Specimen Acceptability and Rejection, and Framework for Identifying Interventions in a Single Tertiary Healthcare Facility.
abstract: OBJECTIVE
  Assessment of specimen rejection rates is an important laboratory quality measure for laboratories because of a potential negative impact on patient care. Here, we examined reasons for specimen rejection at a single, tertiary care healthcare institution and propose a framework for designing an efficient intervention.
  
  
  METHODS
  During a 1-year period, we identified all specimens rejected at our hospital and performed an analysis of a wide range of associated variables: reason for rejection, patient location, type of phlebotomist, tests ordered, priority status, collection container used, transport time.
  
  
  RESULTS
  Clotted and hemolyzed specimens accounted for the majority of rejected specimens, but significant differences in reasons for specimen rejection existed between patient care areas. Eighty-five percent of rejected specimens came from the Emergency Department and eight other inpatient care areas. Registered nurses drew approximately 85% of rejected specimens, while laboratory phlebotomy staff drew only 4%.
  
  
  CONCLUSIONS
  While hemolysis and clotting are primary causes for specimen rejection, collection of all available data regarding specimen rejection data is essential for laboratories determining which factors are most significant causes of specimen rejection.
authors.affiliation: Department of Pathology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rooper
authors.affiliation: Department of Pathology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jamal
authors.initials: J
authors.lastname: Carter
authors.affiliation: Department of Pathology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Hargrove
authors.affiliation: Department of Pathology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors.forename: Sheri
authors.initials: S
authors.lastname: Hoffmann
authors.affiliation: Department of Pathology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland.|Department of Pathology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Riedel
mesh_terms: D001777:Blood Coagulation; D001800:Blood Specimen Collection / Q000592:standards* / Q000706:statistics & numerical data*; D006461:Hemolysis; D006801:Humans; D007753:Laboratories / Q000592:standards* / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D063128:Tertiary Health Care
keywords: laboratory management; laboratory quality assurance; specimen rejection rate