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Reducing sample rejection in Durban, South Africa

  • Thabo Magwai ORCID logo EMAIL logo , Zain Warasally , Naleeni Naidoo and Verena Gounden
Published/Copyright: October 20, 2020
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 59 Issue 4

Abstract

Objectives

Rejections of clinical chemistry specimens delays the availability of results, which may impact patient management. The study aims to measure sample rejection rate, identify reasons for sample rejection, evaluate the effect of a campaign to reduce rejection rates and discover which clinical units produced the most insufficient specimen.

Methods

The study measured specimen rejection rates and the contributions of different rejection reasons in calendar 2016 and April 2018–March 2019. The study undertook a 7-intervention campaign to reduce specimen rejection during the 2018–2019 intervention period. It compared rejections rates, number of months with rejection rates ≤1.2%, and distribution of rejection reasons between the two year-long intervals. The study also determined the origin for specimens rejected for the most common rejection reason during one month in the second period.

Results

The overall rejection rate fell significantly from 1.4% in pre-intervention period to 1.2% in the intervention period. The number of months with rejection rates within the target range increased significantly from 2 in the post-intervention period to 6 in the intervention period. Insufficient, hemolysed, and ‘too-old’ specimen decreased significantly, however, insufficient specimen remained the most frequent rejection reason. In February 2019, one-third of all insufficient specimen came from neonatal units and 24% from the pediatric units.

Conclusions

Interventions decreased significantly both overall and monthly rejection rates above target levels. Insufficient, hemolysed, ‘too-old’ specimen, became significantly less frequent, however, insufficient specimen remained the most frequent rejection reason. Over a month, most insufficient specimen came from neonatal and pediatric sites.

Keywords: pre-analytic error; quality indicators; specimen insufficient; specimen rejections
Corresponding author: Thabo Magwai, Chemical Pathology Department, National Health Laboratory Service, 800 Bellair Road, Mayville, Durban, Kwa-Zulu Natal, 4058, South Africa, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Ethical approval: This quality improvement study audited specimen rejection without interactions with specifically identified patients or their medical record; its ethical clearance was as a routine process monitoring function.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-0827).

Received: 2020-03-19
Accepted: 2020-10-07
Published Online: 2020-10-20
Published in Print: 2021-03-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2020-0827
Keywords for this article
pre-analytic error; quality indicators; specimen insufficient; specimen rejections

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Perspectives in developments of mass spectrometry for improving diagnosis and monitoring of multiple myeloma and other plasma cell disorders
  4. Cytokine “storm”, cytokine “breeze”, or both in COVID-19?
  5. Review
  6. Clinical relevance of biological variation of cardiac troponins
  7. General Clinical Chemistry and Laboratory Medicine
  8. Development of novel methods for non-canonical myeloma protein analysis with an innovative adaptation of immunofixation electrophoresis, native top-down mass spectrometry, and middle-down de novo sequencing
  9. Falsely markedly elevated 25-hydroxyvitamin D in patients with monoclonal gammopathies
  10. Development of a pregnancy-specific reference material for thyroid biomarkers, vitamin D, and nutritional trace elements in serum
  11. Applying the concept of uncertainty to the sFlt-1/PlGF cut-offs for diagnosis and prognosis of preeclampsia
  12. Reducing sample rejection in Durban, South Africa
  13. Quality benchmarking of smartphone laboratory medicine applications: comparison of laboratory medicine specialists’ and non-laboratory medicine professionals’ evaluation
  14. Urine soluble CD163 (sCD163) as biomarker in glomerulonephritis: stability, reference interval and diagnostic performance
  15. Measurement of urine albumin by liquid chromatography-isotope dilution tandem mass spectrometry and its application to value assignment of external quality assessment samples and certification of reference materials
  16. Choice of faecal immunochemical test matters: comparison of OC-Sensor and HM-JACKarc, in the assessment of patients at high risk of colorectal cancer
  17. Reference Values and Biological Variations
  18. Reference values of trace elements in blood and/or plasma in adults living in Belgium
  19. Cancer Diagnostics
  20. Clinical performance of calcitonin and procalcitonin Elecsys® immunoassays in patients with medullary thyroid carcinoma
  21. Cardiovascular Diseases
  22. Analytical assessment of ortho clinical diagnostics high-sensitivity cardiac troponin I assay
  23. Evaluation of the 0 h/1 h high-sensitivity cardiac troponin T algorithm in diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) in Han population
  24. Diabetes
  25. Are hemoglobin A1c point-of-care analyzers fit for purpose? The story continues
  26. Infectious Diseases
  27. Diagnostic and prognostic role of presepsin in patients with cirrhosis and bacterial infection
  28. Hemocytometric characteristics of COVID-19 patients with and without cytokine storm syndrome on the sysmex XN-10 hematology analyzer
  29. Letters to the Editor
  30. Letter in reply to the letter to the editor of Geerts N and Schanhorst V with the title “Roche Troponin T hs-STAT meets all expert opinion analytical laboratory practice recommendations for the use of the differential diagnosis of acute coronary syndrome”
  31. Improving measurement uncertainty of plasma electrolytes: a complex but not impossible task
  32. Truncation limits of patient-based real-time quality control: a new model derived from between-subject biological variations
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  39. Could the UKNEQAS program “Manual Differential Blood Count” be performed by the use of an automated digital morphology analyzer (Sysmex DI-60)? A feasibility study
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