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Safe Preanalytic Component of Total Testing Process

A study that was published in 2002 concluded that the majority of laboratory errors occur in the preanalytic phase of testing.*

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
    • Nerve or tissue damage caused by improper technique or wrong-site venipuncture
  • Requisition errors
    • Patient information missing, illegible, or on wrong patient
    • Wrong tests ordered
  • Patient identification
    • Patient incorrectly identified
    • Specimen not labeled or incorrectly labeled
  • Specimen integrity
    • Not enough specimen for testing
    • Visible hemolysis
    • Inadequate cleansing of venipuncture site resulting in contamination during blood culture collection
    • Specimen centrifuged too long or not long enough
    • Specimen placed in improper preservative
    • Specimen transported at the wrong temperature (eg, specimen that should be placed on ice immediately after collection is transported at ambient temperature)
  • Shipment of specimen
    • Shipped at ambient temperature when it should have been shipped frozen
    • Delay in shipment
  • Order entry
    • Incorrect data entered during manual entry of a test requisition

*Reference: Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine. Clin Chem. 2002;48:691-698. Available at: Accessed November 10, 2015.