Reprocessing Cost Analysis of Specimens Rejected in Laboratory: Results from the Perspective of the Costs to the Hospital

Year 2022, , 67 - 74, 30.03.2022

Enver Bozdemir , Mehmet Nurullah Kurutkan , Melek Terzi

https://doi.org/10.33808/clinexphealthsci.804238

Cited By: 1

Abstract

Objective: The objective of the study is to analyze the additional costs of reprocessing the specimens rejected in the laboratory to the hospital.
Methods: The data is acquired from the Düzce University Medical Application and Research Hospital (DUMARH) laboratories. 5-year (2015-
2019) data was retrospectively reviewed and subjected to document analysis.
Results: The rate of the total rejected specimens has increased throughout the years. (2015, 0.88% – 2019, 2.12%). The most prominent
rejection reasons are hemolysis specimen (32.9%), insufficient specimen (17.25%), clotted specimen (15.4%) and inaccurate examination
request (10.64%). While the reprocessing cost of specimens was 12.085 dollars in 2015, it increased to 51.132 dollars in 2019. It is seen that the
rejection rate has increased as the specimen number increased and the reprocessing costs have increased since the inflation in Turkey increased
and the purchasing power of the hospital has decreased throughout the years.
Conclusion: In order to decrease and prevent the rejected specimen, there is a need for phlebotomy training, especially for nursing and other
healthcare professionals, and strict quality control and standard operating procedures for the pre-analytical phase. These are the critical
approaches that will improve the service quality of laboratories and patient safety.

Keywords

Laboratory, Rejected Specimen, Reprocessing, Cost Analysis

Thanks

We would like to thank Öner Abidin Balbay, the chief physician of Düzce University Research and Application Hospital, for his help and support in this research. We would like to thank Zekeriya Kaplan, hospital information manager, who provided us with the research data.

References

• [1] Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü. Klinik Mikrobiyoloji Laboratuvarları Kalite Yönetimi Rehberi. Ankara; 2014 [accessed 2020 Apr 24]. www.pozitifmatbaa.com.
• [2] Da Rin G. Pre-analytical workstations: A tool for reducing laboratory errors. Clin Chim Acta. 2009;404:68–74. https://doi.org/10.1016/j.cca.2009.03.024.
• [3] Guimarães AC, Wolfart M, Brisolara MLL, et al. Causes of rejection of blood samples handled in the clinical laboratory of a University Hospital in Porto Alegre. Clin Biochem. 2012;45:123–126. https://doi.org/10.1016/j.clinbiochem.2011.10.009.
• [4] Green SF. The cost of poor blood specimen quality and errors in preanalytical processes. Clin Biochem. 2013;46:1175–1179. https://doi.org/10.1016/j.clinbiochem.2013.06.001.
• [5] Goldschmidt H, Lent R. Gross errors and work flow analysis in the clinical laboratory. Klin Biochem Metab. 1995;3:131–140.
• [6] Plebani M, Lippi G. To err is human. To misdiagnose might be deadly. Clin. Biochem. 2010. p. 1–3. https://doi.org/10.1016/j.clinbiochem.2009.07.002.
• [7] ECRI Institute. PSO Monthly Brief From the ECRI Institute PSO Deep Dive: An Examination of “Lab” Errors Check out ECRI Institute. 2014.
• [8] Sağlık Bakanlığı. Güvenlik Raporlama Sistemi 2016 Yılı İstatistik ve Analiz Raporu. 2018 [accessed 2020 Apr 24]. www.grs.saglik.gov.tr.
• [9] Lippi G, Guidi GC. Risk management in the preanalytical phase of laboratory testing. Clin. Chem. Lab. Med. Walter de Gruyter; 2007. p. 720–727. https://doi.org/10.1515/CCLM.2007.167.
• [10] Howanitz PJ. Errors in laboratory medicine: Practical lessons to improve patient safety. Arch Pathol Lab Med. 2005;129:1252–1261. https://doi.org/10.1043/1543-2165(2005)129[1252:EILMPL]2.0.CO;2.
• [11] Güvenç Y. Poliklinik, Servis ve Acil Kanlarında Numune Red Analizi: Eğitim ve Yeni Yaklaşımlar. Türk Klin Biyokim Derg. 2017;15:119–128.
• [12] Shiferaw MB, Yismaw G, Getachew H. Specimen rejections among referred specimens through referral network to the Amhara Public Health Institute for laboratory testing, Bahir Dar, Ethiopia. BMC Res Notes. 2018;11. https://doi.org/10.1186/s13104-018-3891-7.
• [13] Cao L, Chen M, Phipps RA, et al. Causes and impact of specimen rejection in a clinical chemistry laboratory. Clin Chim Acta. 2016;458:154–158. https://doi.org/10.1016/j.cca.2016.05.003.
• [14] Erdal EP, Mitra D, Khangulov VS, et al. The economic impact of poor sample quality in clinical chemistry laboratories: results from a global survey. Ann Clin Biochem. 2017;54:230–239. https://doi.org/10.1177/0004563216651647.
• [15] Maul P, Phelan M, Reineks E, et al. Quantifying the economic impact of poor quality (hemolyzed) blood samples from the emergency department. J Health Care Finance. 2019;45:1–9. https://doi.org/10.1177/0004563216651647.
• [16] Kulkarni S, Piraino D, Strauss R, et al. The Cost of Pre-Analytical Errors in INR Testing at a Tertiary-Care Hospital Laboratory: Potential for Significant Cost Savings. Lab Med. 2019;1–5. https://doi.org/10.1093/labmed/lmz062.
• [17] APHL. Best Practice Guidance: Specimen and Specimen-Product Storage and Retention. 2016.
• [18] Tapper MA, Pethick JC, Dilworth LL, et al. Pre-analytical Errors at the Chemical Pathology Laboratory of a Teaching Hospital. J Clin Diagnostic Res. 2017;11:BC16.
• [19] Atay A, Demir L, Cuhadar S, et al. Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors. Biochem Medica. 2014;24:376–382. https://doi.org/10.11613/BM.2014.040.
• [20] Jandial S, Gosai V. Sample Rejection Rate in Clinical Biochemistry Laboratory of a Tertiary Care Centre. Int J Res Med. 2017;5.
• [21] Forest SK, Shirazi M, Wu-Gall C, et al. The Impact of an Electronic Ordering System on Blood Bank Specimen Rejection Rates. Am J Clin Pathol. 2017;147:105–109. https://doi.org/10.1093/ajcp/aqw204.
• [22] Rooper L, Carter J, Hargrove J, et al. Targeting Rejection: Analysis of Specimen Acceptability and Rejection, and Framework for Identifying Interventions in a Single Tertiary Healthcare Facility. J Clin Lab Anal [Internet]. 2017 [cited 2020 Feb 28];31:e22060. https://doi.org/10.1002/jcla.22060.
• [23] Chawla R, Goswami B, Tayal D, et al. Identification of the Types of Preanalytical Errors in the Clinical Chemistry Laboratory: 1-Year Study at G.B. Pant Hospital. Lab Med. 2010;41:89–92. https://doi.org/10.1309/lm9jxzbmlsvjt9rk.
• [24] Stark A, Jones BA, Chapman D, et al. Clinical laboratory specimen rejection - Association with the site of patient care and patients’ characteristics: Findings from a single health care organization. Arch Pathol Lab Med. 2007;131:588–592. https://doi.org/10.1043/1543-2165(2007)131[588:CLSRWT]2.0.CO;2.
• [25] Fordyce J, Blank FSJ, Pekow P, et al. Errors in a busy emergency department. Ann Emerg Med. 2003;42:324–333. https://doi.org/10.1016/S0196-0644(03)00398-6.