Analysis of the frequency of biological sample recollections as quality indicators in a clinical laboratory of Distrito Federal, Brazil

Coriolano, Natani L.; Silva, Izabel Cristina R.; Lamounier, Thaís A. C.

doi:10.5935/1676-2444.20160002

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Laboratory Medicine • J. Bras. Patol. Med. Lab. 52 (1) • Jan-Feb 2016 • https://doi.org/10.5935/1676-2444.20160002 copy

Analysis of the frequency of biological sample recollections as quality indicators in a clinical laboratory of Distrito Federal, Brazil

Análise da frequência de recoletas de amostras biológicas como indicadores de qualidade em um laboratório de análises clínicas do Distrito Federal, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Clinical laboratory results influence more than 60% of medical decisions, impacting on disease prevention, diagnosis, and treatment. The use of quality indicators (QIs) is fundamental for quality assurance, once it allows monitoring the process and directs the taking of corrective actions.

Objective:

Classify the biological sample recollection requests for QIs identification in a clinical laboratory of Distrito Federal, Brazil.

Material and methods:

Data about the requests made in the biennium 2013-2014 were gathered and analyzed.

Results and discussion:

Among the 304,361 samples received, 1,914 (0.62%) had a request for recollection made in accordance with laboratory criteria. Most orders originated in the pre-analytical phase (57.7%). The most frequent reason for sample rejection was result confirmation (40.7%), followed by insufficient sample (21.9%), coagulated sample (18.1%) and hemolyzed sample (11, 9%). The hematology sector was responsible for most recollection requests (43.6%), followed by the biochemistry (29%) and the immunology (25.7%) ones. The laboratory emergency department accounted for only 0.1%. Orders were mostly placed by the outpatient clinic (40.7%), emergency (30.4%), and internal medicine (12.4%) departments. The percentage of orders is low, but does not exclude the need to reach lower rates. Underreporting was detected in the emergency sector, which indicates need for improvement in information registration.

Conclusion:

The numbers mentioned were selected as IQs for the pre-analytical phase, serving as guidelines for future actions taken by the team.

Key words:
analytical quality control; quality improvement; quality management

		n	%
Year	2013	1,104	57.7
Year	2014	810	42.3
Reason	Pre-analytical phase
	Clotted sample	346	18.1
	Sample collected in inadequate tube	15	0.8
	Contaminated sample	7	0.4
	Hemolized sample	228	11.9
	Insufficient sample	420	21.9
	Sample not found	86	4.5
	Registry error	2	0.1
	Analytical phase
	Lack of reagent	110	5.7
	Post-analytical phase
	Result confirmation	700	36.6
Sex	Female	1,066	55.7
Sex	Male	848	44.3
Age group	Child	336	17.6
	Teenager	99	5.2
	Adult	984	51.4
	Elderly	495	25.9
Laboratory sector	Biochemistry	556	29
	Emergency	2	0.1
	Hematology	835	43.6
	Hormones	29	1.5
	Immunology	492	25.7
Origin of request	Outpatient department	779	40.7
	Nursery	9	0.5
	Bronchoscopy	1	0.1
	Pediatric surgery	4	0.2
	Surgery department	33	1.7
	Internal medicine	238	12.4
	Adult ER	49	2.6
	Pediatric ER	19	1
	Dermatology	1	0.1
	Emergency department	581	30.4
	Hemodialysis	24	1.3
	Maternity ward	20	1
	Labor medicine	5	0.3
	Outpatient pediatric clinic	73	3.8
	Pediatric clinic	49	2.6
	Chemotherapy	1	0.1
	Transplantation	21	1.1
	Neonatal ICU	7	0.4

		Pre-analytical														Analytical		Postanalytical
		Clotted sample		Contaminated sample		Hemolyzed sample		Insufficient sample		Sample not found		Collection in an inadequate tube		Registry error		Lack of reagent		Result confirmation		Total
		n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Sex	Female	187	17.5	4	0.3	123	11.5	217	20.3	44	4.1	9	0.8	2	0.1	65	6	415	39	1,066	100
Sex	Male	159	18.7	3	0.3	105	12.3	203	23.9	42	4.9	6	0.7	0	0	45	5.3	285	34	848	100
Age group	Children	84	25	1	0.29	41	12.2	137	40.77	2	0.59	2	0.59	0	0	21	6.25	48	14.28	336	100
	Adult	133	13.51	6	0.6	96	9.75	156	15.85	63	6.4	8	0.81	1	0.1	60	6.09	461	46.84	984	100
	Elderly	119	24.04	0	0	80	16.16	98	19.79	16	3.23	3	0.6	1	0.2	23	4.64	155	31.31	495	100
Laboratory sector	Hematology	333	39.8	3	0.3	34	4	276	33	43	5.1	5	0.5	0	0	38	4.5	103	12	835	100
	Biochemistry	11	1.9	3	0.5	189	33.9	103	18.5	33	5.9	7	1.2	1	0.1	62	11.1	147	26	556	100
	Immunology	2	0.4	1	0.2	3	0.6	31	6.38	3	0.6	0	0	1	0.2	8	1.6	443	90	492	100
Origin of request	Outpatient department	109	13.9	2	0.2	63	8	102	13	55	7	9	1.1	1	0.1	22	2.8	416	53	779	100
	Emergency department	159	27.3	4	0.6	102	17.5	182	31.3	10	1.7	1	0.1	0	0	56	9.6	67	12	581	100
	Internal medicine	25	10.5	1	0.4	32	13.4	60	25.2	9	3.7	1	0.4	0	0	13	5.4	97	41	238	100

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E-mail: jbpml@sbpc.org.br

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[1] CORRESPONDING AUTHOR: Thaís A. C. Lamounier , Universidade de Brasília; Hospital Universitário; Centro Metropolitano, conjunto A, lote 01, CEP: 72220-900; Brasília-DF, Brasil; e-mail:lamounier@unb.br.