Each rejected specimen
should be recorded in a log book with relevant details.
For each rejected specimen
included in the study, the following information was recorded: patient age, specimen type, laboratory testing section, test priority, time of specimen receipt and time of specimen rejection, rejection reason, detection method used for rejection due to improper labeling, whether or not a recollected or relabeled specimen was requested by the laboratory, time of recollected/ relabeled request, time of recollected/relabeled specimen receipt, recollection method for blood and urine specimens, if applicable, and result time.
.--A specimen that is judged by the laboratory to be unsuitable for analysis or must be recollected (eg, specimen lost or not received, inadequately labeled or unlabeled, hemolyzed, clotted, of insufficient quantity, or of unacceptable variance with previous or expected results).
The Core Laboratory tracks rejected specimens
by such partners as an indicator of process effectiveness.
It may be identified by laboratory personnel to reconcile an entry on the preceding day's log of rejected specimens
, which includes those for which no test has been ordered.
A total of 301 surgical patients were identified; 75 were excluded from the study owing to an absence of laboratory records (42), sinus histology reports without corresponding microbiology reports (29), incomplete microbiology reports (3) and rejected specimens
Solution: Studies have repeatedly shown that a laboratory-based specimen-collection staff commits fewer patient identification and labeling errors and has lower blood culture contamination rates and fewer rejected specimens
. Studies have also shown emergency room specimens are 10 times more likely to be mislabeled than those drawn elsewhere and 20 times more likely to be hemolyzed than those drawn by laboratory personnel, Ernst reports.
In addition, the conclusions were based on the analysis of a single measure of effectiveness, percentage of rejected specimens
. Therefore, the inclusion of other measures of effectiveness including patient satisfaction and complications from the blood collection process (bruising, nerve damage) are recommended for further studies.
We acknowledge that optimal validation of this algorithm would require randomly selecting and testing rejected specimens
during a phase of high disease prevalence.
In some reports, hemolyzed specimens, the most common reason for rejection, account for ~60% of rejected specimens
, fivefold more than the second most common cause (2).
If the scrap rate appears too high, the rejected specimens
can be manually tested for Brinell hardness to salvage some.
Following detailed directions supplemented by telephone advice from QPC staff at the College of American Pathologists, participants recorded the events in the 6 of 7 monitors that produced rates (outpatient order-entry errors, patient ID band defects, rejected specimens
, STAT test receipt-to-report TAT outliers, defective critical value reporting events, and corrected reports).