Contributor

David Wilkins
Essential Insights contributor, healthcare writer
Featured experts

Michael Yates
Kitting Manager, Laboratory Products
Cardinal Health

Brad Jones
Manager, Business Development
Cardinal Health OptiFreight® Logistics
A single contaminated laboratory specimen can trigger a cascade of adverse effects—from misdiagnosis, to delayed or incorrect treatment, the need to repeat tests, prolonged length of stay and, ultimately, reduced patient safety and satisfaction. When factoring in the tens of millions of patients in the U.S. that require blood culture tests every year, this adds up to a considerable amount of wasted time and money for a health system.
On average, 3% of all blood culture tests conducted in the U.S. for sepsis and other bloodstream infections are false-positive due to contamination. This means more than 1 million patients a year are at risk of misdiagnosis, unnecessary treatment with antibiotics and additional days in the hospital.
There is a belief that a small percentage of contaminated specimens is inevitable and that labs lack the authority or ability to influence specimen collection, handling and transport across an organization.
This belief can be a costly misconception.
“There's always room for improvement,” said Michael Yates, a manager for Lab Kitting Services at Cardinal Health. “False-positives are preventable. Getting it right the first time helps lead to improved patient satisfaction and outcomes. When you eliminate some of the errors, you increase physician confidence in the clinical laboratory.”
In many facilities, laboratory teams take a leadership role in the adoption of best practices to improve specimen integrity. “They have a tremendous amount of control over the processes and products used in collection,” Yates said.
Targeting the root of the problem
Improving specimen integrity starts with improving specimen collection. For hospitals, health systems and independent labs looking to reduce their number of rejected specimens, it pays to focus on what occurs before testing takes place. According to Margaret Blaetz, CEO and technical consultant at East Coast Clinical Consultants, nearly three out of four errors occur during the pre-analytical phase of the process.* Therefore, proper collection, handling, storage and shipping are crucial quality control targets for increasing specimen integrity and delivering more accurate results.
The most common mistakes during the pre-analytical phase include:
Collection: Using the wrong tube or swab, underfilling test tubes, poor technique, and improper labeling.
Transport and storage: Centrifuging for the incorrect time or speed, inappropriate shipping temperature or container, light interference, misplacing the specimen, and storing it too long or at the wrong temperature.
Processing: Waiting too long to process the request or misreading the test request.
Patient variables: Contamination at site of collection, fasting or overeating, too much exercise, and collection improperly timed to medication schedule.
Ensuring thorough quality control
To ensure the long-term success of specimen integrity improvements, facilities must regularly and systematically assess the collection procedures used across all phases of the process.
Brad Jones, business development manager at Cardinal Health OptiFreight® Logistics recommends establishing, tracking and evaluating quality indicators at every step. This includes reviewing the specimen rejection log to identify gaps and trends in specimen management.
“You don't know where to focus improvement efforts until you know where your deficiencies are,” Jones said.
Additional specimen quality control best practices that both Yates and Jones recommended include:
- Scheduling regular requisition checks in which randomly selected forms are matched with the information in an online order entry system.
- Standardizing products and utilization. According to Yates, some facilities use as many as five different pregnancy kits, each with a different level of sensitivity. Settling on a single product standardizes protocols, reduces the number of SKUs to manage, garners preferential pricing and simplifies training.
- Conducting quarterly business reviews in which staff from each unit describe the products and processes they use for a particular specimen collection. “I've been in customers' business reviews where everybody demonstrated how they collect a blood culture and everybody did it differently,” Yates said. “Through the review they recognized the inconsistencies and could correct it.”
- Working with a freight management company experienced in the transport of medical samples and knowledgeable about how to maintain specimen integrity. Laboratories are stretched thin by budgetary and regulatory pressures and a shortage of qualified technicians, and a qualified freight company frees them from managing shipping logistics and chasing down lost or delayed shipments. “More and more people are seeing this as a cost effective and efficient way to operate,” Jones added.
- Having detailed, documented corrective action plans to address quality issues as they arise. It's also important to track the impact of improvement efforts and assess the need for further training.
- Working with suppliers to create custom collection kits to help ensure standardization and adherence to specimen collection protocols, simplify workflow and training, minimize contamination and false-positives and improve turnaround times.
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Implementing these practices is a practical path to meaningful improvements in specimen integrity. For facilities with already low error rates, having a clear plan, best practices and vigilance is still a worthwhile endeavor.
“At the end of the day,” Jones said, “there are lives tied to this work.”
* Cardinal Health, 2020, Putting labs to the test: Closing the gap in pre-analytical specimen quality