“Prevalence of Errors in the Clinical Chemistry Laboratory Section of Selected Hospital-based

Laboratories in Tacloban City”

Kim Russel O. Borromeo

Medical Laboratory Science
Doña Remedios Trinidad Romualdez Medical Foundation

Introduction

The last few decades have seen a significant decrease in the rates of analytical

errors in clinical laboratories. Evidence demonstrates that pre- and post-analytical steps of the

total testing process (TTP) are more error-prone than the analytical phase. Most errors are

identified in pre-pre-analytic and post-post-analytic steps outside of the laboratory. In a patient-

centered approach to the delivery of health-care services, there is the need to investigate, in the

TTP, any possible defect that may have a negative impact on the patient. In the interests of

patients, any direct or indirect negative consequence related to a laboratory test must be

considered, irrespective of which step is involved and whether the error depends on a laboratory

professional (e.g. calibration/testing error) or non-laboratory operator (e.g. inappropriate test

request, error in patient identification and/or blood collection). Patient misidentification and

problems communicating results, which affect the delivery of diagnostic services, are recognized

as the main goals for quality improvement. International initiatives aim at improving these

aspects. Grading laboratory errors on the basis of their seriousness should help identify priorities

for quality improvement and encourage a focus on corrective/preventive actions. It is important

to consider not only the actual patient harm sustained but also the potential worst-case outcome

if such an error were to reoccur. The most important lessons we have learned are that system

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theory also applies to laboratory testing and that errors and injuries can be prevented by

redesigning systems that render it difficult for all health-care professionals to make mistakes.

Rationale

Unlike many components of the health care system that are still besieged with the

issue of patient quality outcomes, laboratories have always been forerunners in pursuing quality

in their analytical processes. (Goswani et al., 2010) The concepts and practices of quality

assessment programs have been a routine in laboratory diagnostics. Proficient laboratory service

is the cornerstone of modern health care systems and contributes about 70% towards medical

diagnoses and treatments. (Lippi et al., 2009) Automated innovations have also contributed to a

significant improvement in the field of laboratory science, but errors still prevail. (Hawkins,

2012) These errors are classified as pre-analytical, analytical, and post-analytical.

Advances in science and technology have led to many path-breaking innovations that

have transformed laboratory diagnostics from manual, cumbersome testing methods to fully

automated science, ensuring accuracy and speed. However, the laboratory cannot function in

isolation. It is dependent upon other departments, mainly the clinical division for properly filled

requisition slips and samples for analysis. Mounting evidence indicates that reliability cannot be

achieved in a clinical laboratory through the mere promotion of accuracy in the analytical phase

of the testing process. The phases before the sample reaches the laboratory (pre-analytical), when

it reaches the laboratory and analyzed (analytical), and the phase after the sample is analyzed

(post-analytical) are equally important. (Ranja et al., 2010)

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 Modern day diagnosis is heavily dependent upon reliable laboratory data. It is therefore

pertinent to ensure credibility of the results emanating from the clinical laboratories. Remarkable

advances in automation, sample collection, transport, and dispatch of reports have led to a drastic

improvement in the performance of these laboratories.

But there is a long path to tread before we achieve 100% accuracy and precision. Errors

arising during sample processing are classified into pre-analytical, analytical, and post-analytical,

depending upon their source and time of presentation respectively. The pre-and post-analytical

phases of the process account for 93% of errors. (Boone, 1993)

The goal of the present paper is to enumerate and analyze the prevalence of different pre-

analytical, analytical, and post-analytical errors that surfaced during sample processing in the

clinical chemistry department of selected hospital-based and free standing laboratories around

Tacloban City and to propose and develop strategies pertinent to our settings to minimize their

occurrence.

Project Description

Objective

The overall purpose of the study is to enumerate and analyze the errors present in the

Clinical Chemistry Sections of selected laboratories in Tacloban City and to propose and develop

methods which laboratories may be able to use to reduce the prevalence of the observed errors.

Methodology

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 The study will be utilizing the Descriptive method which will help provide a picture of a

situation as it naturally happens. The researchers will be conducting the study across four

Hospital-based Laboratories in Tacloban City and will be using an adapted Quality Control

Assessment Survey Questionnaire utilizing the Likert-Type Scale Response.

Timeline

Research Section Duration

1. Title 1 week
2. Introduction 1 week
3. Need for this Study 2 weeks
4. Background 3 weeks
5. Objectives 1 week
6. Research Questions and or
Hypothesis 1 week
7. Research Methodology 2
weeks

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8. Data analysis interpretations
and discussions 3 weeks
9. Summary conclusion and
recommendations 2 weeks
10. Reviewing work for final
submission 1 weeks
Research Section Duration
1. Title 1 week
2. Introduction 1 week
3. Need for this Study 2 weeks
4. Background 3 weeks
5. Objectives 1 week
6. Research Questions and or
Hypothesis 1 week

5
7. Research Methodology 2
weeks
8. Data analysis interpretations
and discussions 3 weeks
9. Summary conclusion and
recommendations 2 weeks
10. Reviewing work for final
submission 1 weeks
Research Section Duration

1. Title 1 week

2. Introduction 1 week

3. Background 2 weeks

4. Objectives 1 week

5. Research Questions and or Hypothesis 1 week

6. Gathering Related Studies and

3 weeks
Literature

7. Research Methodology 2 weeks

8. Data Analysis Interpretations and

3 weeks
Discussions

9. Summary conclusion and

2 weeks
recommendations

10. Reviewing work for final submission 1 week

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 Support

Materials/Resources/Support Budget

Bond Papers 1600

Transportation 1000

Researchers will also be requiring support from the funding agency through a Letter of

Recommendation that will be given to the selected Hospital-based Laboratories as means of

verifying the legitimacy of the study.

Contact Information

References

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