How healthcare facilities can improve outcomes with specimen quality control best practices

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.

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.

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.