Introduction

Errors in laboratory medicine can occur at any of the many steps that a specimen passes through, in some cases even before it is processed.^{23 24} In the wards, errors can occur during the creation of the test order by the clinician, collection of the specimen by medical, nursing or laboratory staff and transportation of the specimen to the laboratory. In the laboratory, errors can occur during sorting and specimen receipt, laboratory accessioning and data entry. Many of these errors can have an undesirable outcome on patient safety. Electronic ordering systems are expected to eliminate legibility problems in handwritten orders and to reduce errors in both the wards and the laboratory and improve the quality of the information provided to the laboratory, thus increasing efficiency and effectiveness in the laboratory.²⁵ The pre-analytical phase of the laboratory test process includes all the steps that occur prior to the actual analysis of the specimen in the laboratory. This phase includes patient- and processing-related variables, including patient identification, specimen collection and specimen labelling. The analytical phase relates to the processing of specimens leading to a validated result, and the post-analytical phase begins when the test result is obtained and ends when it is received by the ordering clinician.²⁶

Pre-analytical errors generally include problems associated with test orders. Sometimes clinicians order incorrect tests, inaccurately specify some aspect of the test order, or even forget to order a test altogether. In addition, test orders sometimes fail to reach the laboratory, particularly in settings that use paper orders, which can be dropped, misplaced, or otherwise lost.²⁷ Blood specimens can be unsuitable for testing when, for example, they are too old or of insufficient quantity for an accurate test result to be returned. Specimens can also be taken from the wrong patient, or be collected in the wrong tube or container. Research in this area shows that up to 65% of laboratory errors occur in the pre-analytical phases of the testing cycle,^{24 28} often related to issues involving the identification of patients and the labelling of specimens.²⁹ In 2006, the Royal College of Pathologists of Australasia Quality Assurance Program Pty. Ltd. (RCPA QAP) launched the Key Incident Monitoring and Management Systems (KIMMS) to measure and monitor key incident indicators for pre- and post-analytical areas of laboratory work to help determine the main reasons for specimen misidentification and rejection.³⁰