Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

Managing the Pre- and Post-analytical Phases of the Total Testing Process

  • Hawkins, Robert (Department of Laboratory Medicine, Tan Tock Seng Hospital)
  • Published : 2012.01.01
⟨ Previous Next ⟩

Abstract

For many years, the clinical laboratory's focus on analytical quality has resulted in an error rate of 4-5 sigma, which surpasses most other areas in healthcare. However, greater appreciation of the prevalence of errors in the pre- and post-analytical phases and their potential for patient harm has led to increasing requirements for laboratories to take greater responsibility for activities outside their immediate control. Accreditation bodies such as the Joint Commission International (JCI) and the College of American Pathologists (CAP) now require clear and effective procedures for patient/sample identification and communication of critical results. There are a variety of free on-line resources available to aid in managing the extra-analytical phase and the recent publication of quality indicators and proposed performance levels by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) working group on laboratory errors and patient safety provides particularly useful benchmarking data. Managing the extra-laboratory phase of the total testing cycle is the next challenge for laboratory medicine. By building on its existing quality management expertise, quantitative scientific background and familiarity with information technology, the clinical laboratory is well suited to play a greater role in reducing errors and improving patient safety outside the confines of the laboratory.

Keywords

References

  1. Lundberg GD. Acting on significant laboratory results. JAMA 1981;245: 1762-1763.
  2. Lundberg GD. How clinicians should use the diagnostic laboratory in a changing medical world. Clin Chim Acta 1999;280:3-11. https://doi.org/10.1016/S0009-8981(98)00193-4
  3. Laposata M and Dighe A. "Pre-pre" and "post-post" analytical error: high-incidence patient safety hazards involving the clinical laboratory. Clin Chem Lab Med 2007;45:712-719.
  4. Stroobants AK, Goldschmidt HM, Plebani M. Error budget calculations in laboratory medicine: linking the concepts of biological variation and allowable medical errors. Clin Chim Acta 2003;333:169-176. https://doi.org/10.1016/S0009-8981(03)00181-5
  5. Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 2006;145:488-496. https://doi.org/10.7326/0003-4819-145-7-200610030-00006
  6. Hickner J, Graham DG, Elder NC, Brandt E, Emsermann CB, Dovey S, et al. Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of Family Physicians National Research Network. Qual Saf Health Care 2008;17:194-200. https://doi.org/10.1136/qshc.2006.021915
  7. Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med 2007;49:196-205. https://doi.org/10.1016/j.annemergmed.2006.06.035
  8. Wahls TL and Cram PM. The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC Fam Pract 2007;8:32. https://doi.org/10.1186/1471-2296-8-32
  9. Leape LL. Errors in medicine. Clin Chim Acta 2009;404:2-5. https://doi.org/10.1016/j.cca.2009.03.020
  10. Weissman JS, Rothschild JM, Bendavid E, Sprivulis P, Cook EF, Evans RS, et al. Hospital workload and adverse events. Med Care 2007;45:448- 455. https://doi.org/10.1097/01.mlr.0000257231.86368.09
  11. Leape LL. Striving for perfection. Clin Chem 2002;48:1871-1872.
  12. Kalra J. Medical errors: impact on clinical laboratories and other critical areas. Clin Biochem 2004;37:1052-1062. https://doi.org/10.1016/j.clinbiochem.2004.08.009
  13. Nevalainen D, Berte L, Kraft C, Leigh E, Picaso L, Morgan T. Evaluating laboratory performance on quality indicators with the six sigma scale. Arch Pathol Lab Med 2000;124:516-519.
  14. Plebani M. Exploring the iceberg of errors in laboratory medicine. Clin Chim Acta 2009;404:16-23. https://doi.org/10.1016/j.cca.2009.03.022
  15. Astion ML, Shojania KG, Hamill TR, Kim S, Ng VL. Classifying laboratory incident reports to identify problems that jeopardize patient safety. Am J Clin Pathol 2003;120:18-26. https://doi.org/10.1309/8U5D0MA6MFH2FG19
  16. Kalra J. Medical errors: overcoming the challenges. Clin Biochem 2004; 37:1063-1071. https://doi.org/10.1016/j.clinbiochem.2004.08.008
  17. Kalra J. Medical errors: an introduction to concepts. Clin Biochem 2004; 37:1043-1051. https://doi.org/10.1016/j.clinbiochem.2004.08.007
  18. Rattan A and Lippi G. Frequency and type of preanalytical errors in a laboratory medicine department in India. Clin Chem Lab Med 2008;46: 1657-1659.
  19. Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine. Clin Chem 2002;48:691-698.
  20. Carraro P and Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Clin Chem 2007;53:1338-1342. https://doi.org/10.1373/clinchem.2007.088344
  21. Frankel A, Gandhi TK, Bates DW. Improving patient safety across a large integrated health care delivery system. Int J Qual Health Care 2003;15 (S1):i31-i40. https://doi.org/10.1093/intqhc/mzg075
  22. Plebani M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem 2010;47:101-110. https://doi.org/10.1258/acb.2009.009222
  23. Lippi G and Plebani M. The importance of incident reporting in laboratory diagnostics. Scand J Clin Lab Invest 2009;69:811-813. https://doi.org/10.3109/00365510903307962
  24. Lippi G and Guidi GC. Risk management in the preanalytical phase of laboratory testing. Clin Chem Lab Med 2007;45:720-727.
  25. Wagar EA and Yuan S. The laboratory and patient safety. Clin Lab Med 2007;27:909-930. https://doi.org/10.1016/j.cll.2007.07.002
  26. Plebani M and Carraro P. Mistakes in a stat laboratory: types and frequency. Clin Chem 1997;43:1348-1351.
  27. Hofgartner WT and Tait JF. Frequency of problems during clinical molecular- genetic testing. Am J Clin Pathol 1999;112:14-21. https://doi.org/10.1093/ajcp/112.1.14
  28. O'Kane M. The reporting, classification and grading of quality failures in the medical laboratory. Clin Chim Acta 2009;404:28-31. https://doi.org/10.1016/j.cca.2009.03.023
  29. O'Kane MJ, Lynch PL, McGowan N. The development of a system for the reporting, classification and grading of quality failures in the clinical biochemistry laboratory. Ann Clin Biochem 2008;45:129-134. https://doi.org/10.1258/acb.2007.007097
  30. International Organization for Standardisation. ISO/TS 22367: Medical laboratories - reduction of error through risk management and continual improvement. Geneva: International Organization for Standardisation, 2008.
  31. Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med 2006;44:750-759.
  32. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991;324:377-384. https://doi.org/10.1056/NEJM199102073240605
  33. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370-376. https://doi.org/10.1056/NEJM199102073240604
  34. Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001;322:517-519. https://doi.org/10.1136/bmj.322.7285.517
  35. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in Australian health care study. Med J Aust 1995;163: 458-471.
  36. Aspden P, Corrigan JM, et al. eds. Patient safety: achieving a new standard for care. In: Washington DC: National Academy Press, 2004.
  37. Kohn LT, Corrigan JM, et al. eds. To err is human: building a safer health system. Washington DC: National Academy Press, 2000.
  38. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academy Press, 2001.
  39. Department of Health. An organisation with a memory: report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer. London: The Stationery Office, 2000.
  40. National Quality Forum. Preferred practices for measuring and reporting patient safety and communication in laboratory medicine: a consensus report. Washington DC: National Quality Forum, 2009.
  41. The Joint Commission. National patient safety goals effective july 1, 2011. http://www.jointcommission.org/assets/1/6/NPSG_EPs_Scoring_ LAB_20110707.pdf. (Update on July 2011).
  42. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Phlebotomy issues and quality improvement in results of laboratory testing. Clin Lab 2006;52:217-230.
  43. Lippi G, Fostini R, Guidi GC. Quality improvement in laboratory medicine: extra-analytical issues. Clin Lab Med 2008;28:285-294. https://doi.org/10.1016/j.cll.2007.12.007
  44. Linden JV, Wagner K, Voytovich AE, Sheehan J. Transfusion errors in New York State: an analysis of 10 years' experience. Transfusion 2000; 40:1207-1213. https://doi.org/10.1046/j.1537-2995.2000.40101207.x
  45. Howanitz PJ, Renner SW, Walsh MK. Continuous wristband monitoring over 2 years decreases identification errors: a college of American pathologists Q-tracks study. Arch Pathol Lab Med 2002;126:809-815.
  46. Mercuriali F, Inghilleri G, Colotti MT, Fare M, Biffi E, Vinci A, et al. Bedside transfusion errors: analysis of 2 years' use of a system to monitor and prevent transfusion errors. Vox Sang 1996;70:16-20. https://doi.org/10.1111/j.1423-0410.1996.tb00990.x
  47. Williamson LM, Lowe S, Love EM, Cohen H, Soldan K, McClelland DB, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ 1999;319:16-19. https://doi.org/10.1136/bmj.319.7201.16
  48. Valenstein PN and Sirota RL. Identification errors in pathology and laboratory medicine. Clin Lab Med 2004;24:979-996. https://doi.org/10.1016/j.cll.2004.05.013
  49. Linden JV, Paul B, Dressler KP. A report of 104 transfusion errors in New York State. Transfusion 1992;32:601-606. https://doi.org/10.1046/j.1537-2995.1992.32792391030.x
  50. Lippi G, Bassi A, Brocco G, Montagnana M, Salvagno GL, Guidi GC. Preanalytic error tracking in a laboratory medicine department: results of a 1-year experience. Clin Chem 2006;52:1442-1443. https://doi.org/10.1373/clinchem.2006.069534
  51. Valenstein PN, Raab SS, Walsh MK. Identification errors involving clinical laboratories: a college of American pathologists Q-Probes study of patient and specimen identification errors at 120 institutions. Arch Pathol Lab Med 2006;130:1106-1113.
  52. Kost GJ and Hale KN. Global trends in critical values practices and their harmonization. Clin Chem Lab Med 2011;49:167-176.
  53. Emancipator K. Critical values: ASCP practice parameter. American Society of Clinical Pathologists. Am J Clin Pathol 1997;108:247-253. https://doi.org/10.1093/ajcp/108.3.247
  54. Dighe AS, Rao A, Coakley AB, Lewandrowski KB. Analysis of laboratory critical value reporting at a large academic medical center. Am J Clin Pathol 2006;125:758-764. https://doi.org/10.1309/R53XVC2U5CH6TNG8
  55. Tate KE and Gardner RM. Computers, quality, and the clinical laboratory: a look at critical value reporting. Proc Annu Symp Comput Appl Med Care 1993:193-197.
  56. Shahangian S and Snyder SR. Laboratory medicine quality indicators: a review of the literature. Am J Clin Pathol 2009;131:418-431. https://doi.org/10.1309/AJCPJF8JI4ZLDQUE
  57. Howanitz PJ, Steindel SJ, Heard NV. Laboratory critical values policies and procedures: a college of American pathologists Q-probes study in 623 institutions. Arch Pathol Lab Med 2002;126:663-669.
  58. Joint Commision International. JCI accreditation hospital survey process guide. 4th ed. Oakbrook Terrace, IL: Joint Commission International, 2010.
  59. College of Americal Pathologists. Laboratory accreditation program. Laboratory general checklist. Northfield, IL: College of American Pathologists, 2010.
  60. International Organization for Standardization. ISO 15189: Medical laboratories - particular requirements for quality and competence. Geneva: International Organization for Standardization, 2007.
  61. Don-Wauchope AC and Chetty VT. Laboratory defined critical value limits: how do hospital physicians perceive laboratory based critical values? Clin Biochem 2009;42:766-770. https://doi.org/10.1016/j.clinbiochem.2009.02.016
  62. Cooper G, DeJonge N, Ehrmeyer S, Yundt-Pacheco J, Jansen R, Ricós C, et al. Collective opinion paper on findings of the 2010 convocation of experts on laboratory quality. Clin Chem Lab Med 2011;49:793-802.
  63. Clinical and Laboratory Standards Institute. EP18-A2: Risk management techniques to identify and control laboratory error sources. Approver guideline. 2nd ed. Wayne, PA: Clinical and Laboratory Standards Institute, 2009.
  64. Clinical and Laboratory Standards Institute. EP23-P: Laboratory quality control based on risk management. Wayne, PA: Clinical and Laboratory Standards Institute, 2010.
  65. Clinical and Laboratory Standards Institute. GP32-A: Management of non-conforming laboratory event. Wayne, PA: Clinical and Laboratory Standards Institute, 2007.
  66. Reason J. Human error: models and management. BMJ 2000;320:768- 770. https://doi.org/10.1136/bmj.320.7237.768
  67. Lippi G, Banfi G, Buttarello M, Ceriotti F, Daves M, Dolci A, et al. Recommendations for detection and management of unsuitable samples in clinical laboratories. Clin Chem Lab Med 2007;45:728-736.
  68. The Quality of Diagnostic Samples. Errors in laboratory medicine. http:// www.diagnosticsample.com/home.php3?lang=en (Update on 2009).
  69. World Health Organisation. Use of anticoagulants in diagnostic laboratory investigations. http://whqlibdoc.who.int/hq/2002/WHO_DIL_LAB_ 99.1_Rev.2.pdf (Update on Jan 2002).
  70. Global Preanalytical Scientific Committee. Resource centre. http://www. specimencare.com/index.asp (Update on Nov 2011).
  71. Greiner Bio-One. Venous blood collection. http://www.gbo.com/en/index_ 1593.php. (Update on 2007).
  72. Becton, Dickinson and Company. Newsletters: Labnotes. http://www. bd.com/vacutainer/labnotes/ (Update on 2011).
  73. Radiometer America. Downloads and Links. http://avoidpreanalyticalerrors. com/downloads-link.html. (Update on 2011).
  74. Livesey JH, Ellis MJ, Evans MJ. Pre-analytical requirements. Clin Biochem Rev 2008;29(S1):S11-S15.
  75. Alsina MJ, Alvarez V, Barba N, Bullich S, Cortes M, Escoda I, et al. Preanalytical quality control program - an overview of results (2001-2005 summary). Clin Chem Lab Med 2008;46:849-854.
  76. Khoury M, Burnett L, Mackay MA. Error rates in Australian chemical pathology laboratories. Med J Aust 1996;165:128-130.
  77. Lippi G, Chance JJ, Church S, Dazzi P, Fontana R, Giavarina D, et al. Preanalytical quality improvement: from dream to reality. Clin Chem Lab Med 2011;49:1113-1126.
  78. Llopis MA, Trujillo G, Llovet MI, Tarres E, Ibarz M, Biosca C, et al. Quality indicators and specifications for key analytical-extranalytical processes in the clinical laboratory. Five years' experience using the Six Sigma concept. Clin Chem Lab Med 2011;49:463-470.
  79. Sciacovelli L and Plebani M. The IFCC working group on laboratory errors and patient safety. Clin Chim Acta 2009;404:79-85. https://doi.org/10.1016/j.cca.2009.03.025
  80. Plebani M, Sciacovelli L, Lippi G. Quality indicators for laboratory diagnostics: consensus is needed. Ann Clin Biochem 2011;48:479.
  81. Sciacovelli L, O'Kane M, Skaik YA, Caciagli P, Pellegrini C, Da Rin G, et al. Quality indicators in laboratory medicine: from theory to practice. Preliminary data from the IFCC working group project "Laboratory Errors and Patient Safety". Clin Chem Lab Med 2011;49:835-844.
  82. Wagar EA, Stankovic AK, Wilkinson DS, Walsh M, Souers RJ. Assessment monitoring of laboratory critical values: a college of American pathologists Q-tracks study of 180 institutions. Arch Pathol Lab Med 2007; 131:44-49.
  83. Piva E, Sciacovelli L, Zaninotto M, Laposata M, Plebani M. Evaluation of effectiveness of a computerized notification system for reporting critical values. Am J Clin Pathol 2009;131:432-441. https://doi.org/10.1309/AJCPYS80BUCBXTUH
  84. Piva E, Sciacovelli L, Laposata M, Plebani M. Assessment of critical values policies in Italian institutions: comparison with the US situation. Clin Chem Lab Med 2010;48:461-468.
  85. Barth JH. Clinical quality indicators in laboratory medicine: a survey of current practice in the UK. Ann Clin Biochem 2011;48:238-240. https://doi.org/10.1258/acb.2010.010234
  86. Plebani M, Sciacovelli L, Lippi G. Quality indicators for laboratory diagnostics: consensus is needed. Ann Clin Biochem 2011;48:479.
  87. Lippi G, Guidi GC, Mattiuzzi C, Plebani M. Preanalytical variability: the dark side of the moon in laboratory testing. Clin Chem Lab Med 2006; 44:358-365.
  88. Howanitz PJ. Errors in laboratory medicine: practical lessons to improve patient safety. Arch Pathol Lab Med 2005;129:1252-1261.
  89. Hawkins RC. Laboratory turnaround time. Clin Biochem Rev 2007;28: 179-194.
  90. Howanitz PJ, Cembrowski GS, Steindel SJ, Long TA. Physician goals and laboratory test turnaround times. A college of American pathologists Q-probes study of 2763 clinicians and 722 institutions. Arch Pathol Lab Med 1993;117:22-28.
  91. Steindel SJ and Howanitz PJ. Physician satisfaction and emergency department laboratory test turnaround time. Arch Pathol Lab Med 2001; 125:863-871.
  92. Valenstein P and Schifman RB. Duplicate laboratory orders: a college of American pathologists Q-Probes study of thyrotropin requests in 502 institutions. Arch Pathol Lab Med 1996;120:917-921.
  93. Hawkins RC. Potentially inappropriate repeat laboratory testing in inpatients. Clin Chem 2006;52:784-785. https://doi.org/10.1373/clinchem.2005.064139
  94. Bates DW, Kuperman GJ, Rittenberg E, Teich JM, Fiskio J, Ma'luf N, et al. A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. Am J Med 1999;106:144-150. https://doi.org/10.1016/S0002-9343(98)00410-0
  95. Bates DW, Boyle DL, Rittenberg E, Kuperman GJ, Ma'Luf N, Menkin V, et al. What proportion of common diagnostic tests appear redundant? Am J Med 1998;104:361-368. https://doi.org/10.1016/S0002-9343(98)00063-1
  96. Guidi GC, Lippi G, Solero GP, Poli G, Plebani M. Managing transferability of laboratory data. Clin Chim Acta 2006;374:57-62. https://doi.org/10.1016/j.cca.2006.06.009
  97. Plebani M, Ceriotti F, Messeri G, Ottomano C, Pansini N, Bonini P. Laboratory network of excellence: enhancing patient safety and service effectiveness. Clin Chem Lab Med 2006;44:150-160.
  98. Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of "corollary orders" to prevent errors of omission. J Am Med Inform Assoc 1997;4:364-375. https://doi.org/10.1136/jamia.1997.0040364
  99. Smith BJ and McNeely MD. The influence of an expert system for test ordering and interpretation on laboratory investigations. Clin Chem 1999; 45:1168-1175.
  100. Poley MJ, Edelenbos KI, Mosseveld M, van Wijk MA, de Bakker DH, van der Lei J, et al. Cost consequences of implementing an electronic decision support system for ordering laboratory tests in primary care: evidence from a controlled prospective study in the Netherlands. Clin Chem 2007;53:213-219.
  101. Plebani M. Appropriateness in programs for continuous quality improvement in clinical laboratories. Clin Chim Acta 2003;333:131-139. https://doi.org/10.1016/S0009-8981(03)00177-3

Cited by

  1. Quality Indicators of the Pre-Analytical Phase vol.31, pp.3, 2012, https://doi.org/10.2478/v10011-012-0013-2
  2. Does Laboratory Automation for the Preanalytical Phase Improve Data Quality? vol.18, pp.5, 2012, https://doi.org/10.1177/2211068213488892
  3. Preanalytical considerations in blood gas analysis vol.23, pp.1, 2012, https://doi.org/10.11613/bm.2013.005
  4. Quality Management and Accreditation in a Mixed Research and Clinical Hair Testing Analytical Laboratory Setting—A Review vol.35, pp.3, 2013, https://doi.org/10.1097/ftd.0b013e31828526b4
  5. “Sfidare il TAT”: la giusta reciprocità tra Medicina di Laboratorio e Clinica al servizio del paziente vol.9, pp.2, 2013, https://doi.org/10.1007/s13631-013-0008-0
  6. Empfehlungen zur Häufigkeit der Anforderung von Laboruntersuchungen vol.38, pp.5, 2012, https://doi.org/10.1515/labmed-2014-0016
  7. Empfehlungen zur Häufigkeit der Anforderung von Laboruntersuchungen vol.38, pp.5, 2012, https://doi.org/10.1515/labmed-2014-0016
  8. Recommendations for the frequency of ordering laboratory testing vol.38, pp.5, 2012, https://doi.org/10.1515/labmed-2014-0045
  9. Recommendations for the frequency of ordering laboratory testing vol.38, pp.5, 2012, https://doi.org/10.1515/labmed-2014-0045
  10. Point-of-Care Blood Glucose Meter Accuracy in the Hospital Setting vol.27, pp.3, 2012, https://doi.org/10.2337/diaspect.27.3.174
  11. Risk analysis and management of non-conformities of the pre-analytical phase in a university testing laboratory of bacteriology vol.5, pp.1, 2012, https://doi.org/10.5897/jmld2013.0084
  12. Types and Frequency of Errors during Different Phases of Testing At a Clinical Medical Laboratory of a Teaching Hospital in Tehran, Iran vol.6, pp.5, 2012, https://doi.org/10.4103/1947-2714.132941
  13. Institutional practices and policies in acid-base testing: a self reported Croatian survey study on behalf of the Croatian society of medical biochemistry and laboratory medicine Working Group for aci vol.24, pp.2, 2012, https://doi.org/10.11613/bm.2014.031
  14. Analysis of Preanalytical Nonconformance in a Medium-Sized Private Pathology Laboratory vol.142, pp.6, 2014, https://doi.org/10.1309/ajcpbnpx8h1dgvhp
  15. The preanalytic phase in veterinary clinical pathology vol.44, pp.1, 2012, https://doi.org/10.1111/vcp.12206
  16. Evaluation of Analytical Errors in a Clinical Chemistry Laboratory: A 3 Year Experience vol.5, pp.1, 2015, https://doi.org/10.4103/2141-9248.149763
  17. Advances in Smartphone-Based Point-of-Care Diagnostics vol.103, pp.2, 2012, https://doi.org/10.1109/jproc.2014.2378776
  18. A Cost-Effective Interdisciplinary Approach to Microbiologic Send-Out Test Use vol.139, pp.2, 2015, https://doi.org/10.5858/arpa.2013-0693-oa
  19. Use of quality indicators to compare point-of-care testing errors in a neonatal unit and errors in a STAT central laboratory vol.53, pp.2, 2012, https://doi.org/10.1515/cclm-2013-1053
  20. Use of quality indicators to compare point-of-care testing errors in a neonatal unit and errors in a STAT central laboratory vol.53, pp.2, 2012, https://doi.org/10.1515/cclm-2013-1053
  21. Preanalytic errors in anatomic pathology: study of 10,574 cases from five Portuguese hospitals vol.2, pp.3, 2012, https://doi.org/10.1515/dx-2015-0005
  22. Preanalytic errors in anatomic pathology: study of 10,574 cases from five Portuguese hospitals vol.2, pp.3, 2012, https://doi.org/10.1515/dx-2015-0005
  23. The Role of Clinical Virology Laboratory and the Clinical Virology Laboratorian in Ensuring Effective Surveillance for Influenza and Other Respiratory Viruses: Points to Consider and Pitfalls to Avoid vol.8, pp.3, 2012, https://doi.org/10.1007/s40506-016-0081-9
  24. Lean and Agile Point-of-Care Diagnostic Services Quality Systems Management for Low- and Middle-Income Countries vol.15, pp.4, 2016, https://doi.org/10.1097/poc.0000000000000111
  25. Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections vol.2016, pp.None, 2012, https://doi.org/10.1155/2016/2625870
  26. Pre-analytical phase in clinical chemistry laboratory vol.5, pp.3, 2012, https://doi.org/10.15380/2277-5706.jcsr.15.062
  27. A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria vol.9, pp.1, 2016, https://doi.org/10.5812/jjm.29766
  28. Using Gagne’s instructional model in phlebotomy education vol.7, pp.None, 2016, https://doi.org/10.2147/amep.s110357
  29. Test Cancellation: A College of American Pathologists Q-Probes Study vol.140, pp.2, 2016, https://doi.org/10.5858/arpa.2015-0022-cp
  30. Failure to review STAT clinical laboratory requests and its economical impact vol.26, pp.1, 2012, https://doi.org/10.11613/bm.2016.005
  31. Standardization in laboratory medicine: Adoption of common reference intervals to the Croatian population vol.6, pp.1, 2012, https://doi.org/10.5662/wjm.v6.i1.93
  32. Impact of Continuous Improvement of Laboratory Test Result Comments on Requests for Consultation: Table 1 : A Case Series vol.145, pp.5, 2012, https://doi.org/10.1093/ajcp/aqw020
  33. Does Elimination of a Laboratory Sample Clotting Stage Requirement Reduce Overall Turnaround Times for Emergency Department Stat Biochemical Testing? vol.8, pp.10, 2012, https://doi.org/10.7759/cureus.819
  34. Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study vol.72, pp.9, 2017, https://doi.org/10.1093/jac/dkx163
  35. Integrating Electronic Systems for Requesting Clinical Laboratory Test into Digital Clinical Records: Design and Implementation vol.9, pp.4, 2012, https://doi.org/10.4236/health.2017.94044
  36. Errors of Clinical Laboratory and Its Impact on Patient Safety vol.5, pp.3, 2012, https://doi.org/10.4236/jss.2017.53022
  37. Haemocompatibility of Modified Nanodiamonds vol.10, pp.4, 2017, https://doi.org/10.3390/ma10040352
  38. Large-Scale Analysis Evaluating Regional Variability in the Request of Laboratory Tests in Primary Care and its Potential Economic Impact vol.48, pp.3, 2012, https://doi.org/10.1093/labmed/lmx051
  39. Impact of Fasting on Complete Blood Count Assayed in Capillary Blood Samples vol.48, pp.4, 2012, https://doi.org/10.1093/labmed/lmx044
  40. Standardization and validation of Dot-ELISA assay for Paracoccidioides brasiliensis antibody detection vol.23, pp.1, 2012, https://doi.org/10.1186/s40409-017-0101-3
  41. Congruity in Quality Indicators and Laboratory Performance vol.33, pp.3, 2018, https://doi.org/10.1007/s12291-017-0687-9
  42. Decreasing Histology Turnaround Time Through Stepwise Innovation and Capacity Building in Rwanda vol.4, pp.None, 2012, https://doi.org/10.1200/jgo.17.00081
  43. ctDNA and CTCs in Liquid Biopsy – Current Status and Where We Need to Progress vol.16, pp.None, 2018, https://doi.org/10.1016/j.csbj.2018.05.002
  44. Errors in the Total Testing Process in the Clinical Chemistry Laboratory at the University of Gondar Hospital, Northwest Ethiopia vol.28, pp.2, 2018, https://doi.org/10.4314/ejhs.v28i2.15
  45. A two-stage stochastic programming model for phlebotomist scheduling in hospital laboratories vol.7, pp.2, 2012, https://doi.org/10.1057/s41306-017-0033-8
  46. Racing for results: lessons learnt in improving the efficiency of HIV viral load and early infant diagnosis result delivery from laboratory to clinic vol.18, pp.9, 2012, https://doi.org/10.1080/14737159.2018.1503951
  47. Computer-assisted interventions in the clinical laboratory process improve the diagnosis and treatment of severe vitamin B12 deficiency vol.56, pp.9, 2012, https://doi.org/10.1515/cclm-2017-1116
  48. Quality assurance of genetic laboratories and the EBTNA practice certification, a simple standardization assurance system for a laboratory network vol.2, pp.4, 2012, https://doi.org/10.2478/ebtj-2018-0052
  49. Long story short: an introduction to the short-term and longterm Six Sigma quality and its importance in laboratory medicine for the management of extra-analytical processes vol.56, pp.11, 2018, https://doi.org/10.1515/cclm-2018-0310
  50. Long story short: an introduction to the short-term and longterm Six Sigma quality and its importance in laboratory medicine for the management of extra-analytical processes vol.56, pp.11, 2018, https://doi.org/10.1515/cclm-2018-0310
  51. Errors in the Hematology Laboratory at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia vol.11, pp.None, 2012, https://doi.org/10.1186/s13104-018-3551-y
  52. Test Result Management Practices of Canadian Internal Medicine Physicians and Trainees vol.34, pp.1, 2012, https://doi.org/10.1007/s11606-018-4656-7
  53. European follow-up of incorrect biomarker results for colorectal cancer demonstrates the importance of quality improvement projects vol.475, pp.1, 2012, https://doi.org/10.1007/s00428-019-02525-9
  54. A critical review of laboratory performance indicators vol.56, pp.7, 2012, https://doi.org/10.1080/10408363.2019.1641789
  55. Use of microbiology tests in the era of increasing AMR rates– a multicentre hospital cohort study vol.8, pp.1, 2019, https://doi.org/10.1186/s13756-019-0480-z
  56. ASVCPGuidelines: Principles of Quality Assurance and Standards for Veterinary Clinical Pathology (version 3.0) : Developed by the American Society for Veterinary Clinical Pathology's (A vol.48, pp.4, 2012, https://doi.org/10.1111/vcp.12810
  57. ASVCPGuidelines: Principles of Quality Assurance and Standards for Veterinary Clinical Pathology (version 3.0) : Developed by the American Society for Veterinary Clinical Pathology's (A vol.48, pp.4, 2012, https://doi.org/10.1111/vcp.12810
  58. Roots of the total testing process vol.7, pp.1, 2012, https://doi.org/10.1515/dx-2019-0065
  59. Frequency and classification of errors in laboratory medicine at a veterinary teaching hospital in the United States vol.49, pp.2, 2012, https://doi.org/10.1111/vcp.12851
  60. Real‐time display of laboratory testing status improves satisfaction levels in an emergency department: A pilot study vol.34, pp.7, 2012, https://doi.org/10.1002/jcla.23290
  61. Current Practice and Regional Variability in Recommendations for Patient Preparation for Laboratory Testing in Primary Care vol.51, pp.3, 2012, https://doi.org/10.1093/labmed/lmz092
  62. The clinically effective use of cardiac markers by restructuring laboratory profiles at Cardiology wards vol.58, pp.9, 2020, https://doi.org/10.1515/cclm-2019-1229
  63. Biological variation: Understanding why it is so important? vol.23, pp.None, 2012, https://doi.org/10.1016/j.plabm.2020.e00199
  64. Termination of Repeat Testing in Chemical Laboratories Based on Practice Guidelines: Examining the Effect of Rule-Based Repeat Testing in a Transplantation Center vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/9955990
  65. Evidence-based approach to setting delta check rules vol.58, pp.1, 2021, https://doi.org/10.1080/10408363.2020.1800585
  66. Measurement uncertainty as a universal concept: can it be universally applicable in routine laboratory practice? vol.58, pp.2, 2012, https://doi.org/10.1080/10408363.2020.1784838
  67. Questionnaire survey: The process of quality management in the preanalytical phase of laboratory examination in the department of joint laboratories vol.23, pp.1, 2012, https://doi.org/10.32725/kont.2021.003
  68. Automation of extra-analytical phase for clinical laboratory vol.46, pp.2, 2012, https://doi.org/10.1515/tjb-2020-0138
  69. Brazilian laboratory indicators benchmarking program: three-year experience on pre-analytical quality indicators vol.8, pp.2, 2012, https://doi.org/10.1515/dx-2020-0043
  70. Genetic testing for homologous recombination repair (HRR) in metastatic castration-resistant prostate cancer (mCRPC): challenges and solutions vol.12, pp.16, 2012, https://doi.org/10.18632/oncotarget.28015
  71. Effects of circadian variation, lifestyle and environment on hematological parameters: A narrative review vol.43, pp.5, 2021, https://doi.org/10.1111/ijlh.13590
  72. Economic Evaluation of Total Laboratory Automation in the Clinical Laboratory of a Tertiary Care Hospital vol.42, pp.1, 2022, https://doi.org/10.3343/alm.2022.42.1.89