Specimen rejection in laboratory medicine: Necessary for patient safety?

Introduction

The emergency laboratory in Hacettepe University Hospitals receives specimens from emergency departments (EDs), inpatient services and intensive care units (ICUs). The samples are accepted according to the rejection criteria of the laboratory. In this study, we aimed to evaluate the sample rejection ratios according to the types of pre-preanalytical errors and collection areas.

Materials and methods

The samples sent to the emergency laboratory were recorded during 12 months between January to December, 2013 in which 453,171 samples were received and 27,067 specimens were rejected.

Results

Rejection ratios was 2.5% for biochemistry tests, 3.2% for complete blood count (CBC), 9.8% for blood gases, 9.2% for urine analysis, 13.3% for coagulation tests, 12.8% for therapeutic drug monitoring, 3.5% for cardiac markers and 12% for hormone tests. The most frequent rejection reasons were fibrin clots (28%) and inadequate volume (9%) for biochemical tests. Clotted samples (35%) and inadequate volume (13%) were the major causes for coagulation tests, blood gas analyses and CBC. The ratio of rejected specimens was higher in the EDs (40%) compared to ICUs (30%) and inpatient services (28%). The highest rejection ratio was observed in neurology ICU (14%) among the ICUs and internal medicine inpatient service (10%) within inpatient clinics.

Conclusions

We detected an overall specimen rejection rate of 6% in emergency laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 2%, improve total quality management of the emergency laboratory and promote patient safety.Key words: clinical laboratory services, total quality management, patient safety, preanalytical phase, preanalytical error     

The rich or the poor? Personal resources,do-it-yourself,and innovation in the household sector

Household sector innovation is significant in scale and scope. Thus far, it has been studied in isolation and with mixed evidence regarding the role of personal resources (consumers' income and discretionary time). We recognize that household sector innovation is embedded in the broader phenomenon of do-it-yourself (DIY) by consumers, as the literature reveals conceptual similarities, parallel motivations, and antecedents. The main distinction is that, whereas DIY goods may replicate existing products, household sector innovation is restricted to goods embodying a novel function. We explore if studying household sector innovation and DIY in an integrated framework helps to resolve previous inconsistent evidence on the role of personal resources. Based on a neoclassical model in which agents optimize their time allocation, we hypothesize that income and discretionary time positively relate to their DIY output, but—given that agents develop DIY goods—we hypothesize that income negatively relates to innovation. For discretionary time, we formulate a research question regarding its effect on innovation which we answer empirically. Our findings suggest that consumers with more personal resources derive more process benefits from DIY but that these benefits crowd out individuals' focus on the function of their objects, hence, the likelihood of developing innovations. Survey data from the United Arab Emirates (n = 2728) confirm our suppositions, showing that the relationship between personal resources and household sector innovation is more refined than suggested by previous studies.     

Fertility or sterility? Darwin,Naudin and the problem of experimental hybridity

Darwin came to realize that he could never devise an experiment that would demonstrate the development of new species by crossing hybrids. Instead, he turned to the problem of sterility within a species. The difference between Darwin's experimental and theoretical approach and that of French scientists working in the Muséum d'Histoire Naturelle in Paris can be shown most vividly by tracking Darwin's experiments in botany and his interest in those of Charles Naudin on hybrid plants. In his discussion of Mendel, Robert Olby has provided an interesting analysis of Naudin's hereditary concepts. I have approached some of the same work here with an emphasis on the question of sterility raised by Darwin, not simply between hybrids but within members of the same species and the light that he thought this could throw on both heredity and the origin of species.     

Are patients well informed about the fasting requirements for laboratory blood testing?

Introduction:

Proper preparation of the individual is a key prerequisite for ensuring the quality of laboratory testing. Our hypothesis was that many outpatients are not sufficiently familiar with the correct way of preparing for the laboratory tests, for which the individual needs to be at fasting. This study aimed to investigate: i) whether patients are aware of how they need to prepare properly for laboratory tests; ii) the way in which users are informed about how to prepare for laboratory testing; and iii) whether users arrive to the laboratory for phlebotomy properly prepared.

Materials and methods:

An anonymous questionnaire was conducted on 150 outpatients older than 18 years, during February 2013. The response rate was 11%. All patients were interviewed by the laboratory staff. Patients were informed about detail of the questionnaire and agreed to participate in the survey.

Results:

Out of the total number subjects, 39% were fully aware of the proper definition of the fasting, whereas even 46% subjects replied that the last meal has to be taken the day before and the exact time that must pass after the last meal to blood sampling is not important. Furthermore, 52% subjects did not receive any information about how they need to prepare themselves properly for blood testing. Only 60% of them came properly prepared for the laboratory blood testing.

Conclusions:

Substantial proportion of patients do not come properly prepared for laboratory testing. We conclude that patients are not well informed about the fasting requirements for laboratory blood testing. Moreover, requesting physician is the preferred source of information from which patients learn how to prepare themselves for phlebotomy.     

Zero,single, or multi? Genre of web pages through the users’ perspective

The goal of the study presented in this article is to investigate to what extent the classification of a web page by a single genre matches the users’ perspective. The extent of agreement on a single genre label for a web page can help understand whether there is a need for a different classification scheme that overrides the single-genre labelling. My hypothesis is that a single genre label does not account for the users’ perspective. In order to test this hypothesis, I submitted a restricted number of web pages (25 web pages) to a large number of web users (135 subjects) asking them to assign only a single genre label to each of the web pages. Users could choose from a list of 21 genre labels, or select one of the two ‘escape’ options, i.e. ‘Add a label’ and ‘I don’t know’. The rationale was to observe the level of agreement on a single genre label per web page, and draw some conclusions about the appropriateness of limiting the assignment to only a single label when doing genre classification of web pages. Results show that users largely disagree on the label to be assigned to a web page.     

Biotechnology in the Netherlands: controversy or consensus?

This paper addresses the issue of public perception of modern biotechnology in the Netherlands. Contrary to expectations, data from the 1999 Eurobarometer on biotechnology indicate that the position of the Dutch public in general is rather ambiguous, which is in contrast to many of its neighboring countries. The issue is described in terms of differences between the Netherlands and other European countries on political-economic, social-cultural, or media coverage indicators. On many indicators, the Dutch population differs from that of other European countries, and the Dutch opinion-leading media present a rather balanced perspective on modern biotechnology.     

Sicily or the Sea of Tranquility? Mapping and naming the moon

In their race to provide the ultimate guide to the moon, two 17th-century astronomers proposed lunar maps and nomenclatures that they hoped would gain international currency. But the names we use today were those proposed by the Jesuit, a friend of Galileo's persecutors, in a book whose purpose was to refute the Copernican system once and for all. We now believe that Riccioli was wrong about the universe, but why do we still use his nomenclature? The keys to this foundational visual debate in astronomical image-making are the moon maps themselves.     

Could light meal jeopardize laboratory coagulation tests?

Background:

Presently the necessity of fasting time for coagulation tests is not standardized. Our hypothesis is that this can harm patient safety. This study is aimed at evaluating whether a light meal (i.e. breakfast) can jeopardize laboratory coagulation tests.

Materials and methods:

A blood sample was firstly collected from 17 fasting volunteers (12 h). Immediately after blood collection, the volunteers consumed a light meal. Then samples were collected at 1, 2 and 4 h after the meal. Coagulation tests included: activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fbg), antithrombin III (AT), protein C (PC) and protein S (PS). Differences between samples were assessed by Wilcoxon ranked-pairs test. The level of statistical significance was set at P < 0.05. Mean % differences were determined and differences between and baseline and 1, 2 and 4h samples were compared with reference change value (RCV).

Results:

A significantly higher % activity of AT was observed at 1 h and 4 h after meal vs. baseline specimen [113 (104–117) and 111 (107–120) vs. 109 (102–118), respectively; P = 0.029 and P = 0.016]. APTT at 2 h was found significantly lower than baseline samples [32.0 (29.9–34.8) vs. 34.1 (32.2–35.2), respectively; P = 0.041]. The results of both Fbg and PS tests were not influenced by a light meal. Furthermore, no coagulation tests had significant variation after comparison with RCV.

Conclusion:

A light meal does not influence the laboratory coagulation tests we assessed, but we suggest that the laboratory quality managers standardize the fasting time for all blood tests at 12 hours, to completely metabolize the lipids intake.     

The media and the public opinion on genetics and biotechnology: mirrors, windows, or walls?

Arguments regarding the relationship between media discourse and public opinion have raged for decades, if not centuries. COmparing media coverage of biotechnology between 1992 and 2001 in two national newspapers with national survey data collected in early 2003, an argument is made that a general one-dimensional media effect is not occurring within the US public regarding media discourse. Given the multivalent characteristics of the media and the interpretive filters used by audiences - including ignoring information - even strong slants by the presumed opinion-leading press (the New York Times and the Washington Post) do not predict public opinion on a nascent issue such as biotechnology. While some observations show these mirrors to be ephemeral.     

Entrepreneurs, Jacks of all trades or Hobos?

Lazear (2005) suggests that entrepreneurs should be generalists, while those who work for others should be specialists. Many prospective entrepreneurs will develop varied skills by engaging in a variety of employment activities prior to becoming an entrepreneur, and incomes are higher for those that do so. An alternative view predicts that those with greater taste for variety are more likely to become entrepreneurs. Varied employment prior to becoming an entrepreneur is simply an expression of this taste, and is associated with lower earnings. Data from a survey of 830 independent inventors and 300 individuals from the general population are used to discriminate between these two theories. The results show that inventor-entrepreneurs typically have a more varied labor market experience, and that varied work experience is associated with lower household income.