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The page below is a sample from the LabCE course Risk Management in the Clinical Laboratory. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Preanalytic Phase

The preanalytic phase of testing includes all processes prior to the actual testing of a specimen. A study that was published in 2002 concluded that 68 - 87% of laboratory errors occur in the preanalytic and postanalytic stages of the testing process with the majority occurring in the preanalytic phase.*
Steps in the preanalytic phase occur both inside and outside the laboratory and are performed by both laboratory and non-laboratory personnel. While the following list is not exhaustive, some of the most common sources of error in the preanalytic phase include:
  • Patient preparation
    • Patient not told to be fasting; improper or no instruction to patient on proper collection of specimen such as clean catch urine
  • Patient injured during phlebotomy
    • Development of hematoma resulting in no specimen obtained for testing
  • Requisition errors
    • Patient information missing, illegible, or on wrong patient; wrong tests ordered
  • Patient identification
    • Patient incorrectly identified
  • Labeling of specimen
    • Specimen not labeled or incorrectly labeled
  • Preparation of specimen
    • Specimen centrifuged too long or not long enough; specimen placed in improper preservative
  • Storage of specimen
    • Specimen not refrigerated or frozen as required or refrigerated when it should be at ambient temperature
  • Shipment of specimen
    • Shipped at ambient temperature when it should have been shipped frozen; delay in shipment
  • Accessioning process including preparation for analysis
    • Sorted into wrong batch; incorrect labeling
  • Order entry
    • Incorrect data entered during manual entry of a test requisition
  • Specimen sub-optimal
    • Not enough specimen for testing; visible hemolysis
  • Contamination
    • Inadequate cleansing of venipuncture site resulting in contamination during blood culture collection
*Reference: Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine. Clin Chem. 2002;48:691-698. Available at http://www.clinchem.org/content/48/5/691.full#T2B. Accessed September 11, 2019.