|Year : 2022 | Volume
| Issue : 3 | Page : 676-679
Evaluation of completeness of hematology requisition forms leading preanalytical errors in laboratory of a tertiary care teaching hospital
Ramanan Duraiswami1, Varun Vijay Gaiki2
1 Department of Pathology, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
2 Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
|Date of Submission||13-Aug-2020|
|Date of Decision||18-Jun-2021|
|Date of Acceptance||01-Dec-2021|
|Date of Web Publication||2-Nov-2022|
Dr. Varun Vijay Gaiki
Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad - 500 087, Telangana
Source of Support: None, Conflict of Interest: None
Background: Laboratory services provide crucial information for the optimal management of patients in a hospital setting. A crucial step in the preanalytical phase of sample testing is the correct filling up of the laboratory requisition form (LRF). Objectives: this study as planned to identify the possible parameters for pre analytical errors. Methodology: We analyzed the LRF submitted to the Hematology Section of Central Laboratory of a tertiary care teaching hospital from Hyderabad to assess the degree of completeness of the submitted LRF as a cause of preanalytical error in the laboratory workflow. Randomly selected laboratory forms submitted along with specimens to the Central Hematology Laboratory of a tertiary hospital over a period of 1 month for their completeness, as laid down in standard operating procedures. Collected data were entered in an Microsoft Excel Worksheet and analyzed by SPSS version 23. Only the patient's name, identification number, gender, type of sample, and examination requested were correctly filled. Results: Patient contact details were available only in 0.82% of LRFs. The diagnosis and clinical history were correctly filled in only 39.62% and 0.27% LRFs, respectively. There was a significant lack of information regarding the doctor requesting the investigation (doctor's name written in 8.47% of forms and doctor's contact telephone number written in 0.27% of forms evaluated). It was also found that the present format of the LRF was inadequate for providing the necessary details of the samples received. Conclusion: The existing LRF needs to be re-designed to enable the clinicians to provide more clinical details and patient-related details. Clinicians need to be sensitized regarding the necessity of submitting correctly filled LRFs. The use of system generated online requisition forms can also be done, where forms cannot be submitted unless complete.
Keywords: Laboratory quality management systems, laboratory request forms, preanalytical errors
|How to cite this article:|
Duraiswami R, Gaiki VV. Evaluation of completeness of hematology requisition forms leading preanalytical errors in laboratory of a tertiary care teaching hospital. J Datta Meghe Inst Med Sci Univ 2022;17:676-9
|How to cite this URL:|
Duraiswami R, Gaiki VV. Evaluation of completeness of hematology requisition forms leading preanalytical errors in laboratory of a tertiary care teaching hospital. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 8];17:676-9. Available from: http://www.journaldmims.com/text.asp?2022/17/3/676/360208
| Introduction|| |
Efficient laboratory services are a significant cornerstone of patient care in any modern health-care institution. Laboratory test results contribute significantly in the process of clinical decision-making by providing essential information to the clinician regarding the patient. The total testing process (TTP) consists of three phases, preanalytical, analytical, and postanalytical. Correct reporting requires that all the phases, that is, preanalytical, analytical, and postanalytical should be free from errors, as far as possible. It has been estimated that up to 62%–70% of laboratory reporting errors occur in the preanalytical phase.,
The laboratory requisition form (LRF) is the first and critical link in the two-way communication between the laboratory and stakeholders in the health-care system (doctors, nurses, patients, and relatives)., Requesting clinicians may not fully utilize this part to be included in methodology, not in introduction important communication medium. Inadequate or incorrect information on LRF may adversely affect the quality of laboratory reports and hence patient care. ISO 15189:2012 lays down the criteria for correct filling of LRFs.
| Materials and Methods|| |
We analyzed total of 366 LRFs submitted along with specimens to the hematology section of the Central Laboratory of a tertiary care teaching hospital over a period of 1 month to assess the degree of compliance with instructions on correct filling up of LRF contained in the Standard Operating Procedure of the hospital issued in December 2016 which is based on International Standards. Collected data were entered in an Microsoft Excel Worksheet and analyzed by IBM SPSS v23. The information that needs to be filled in the LRF is given in [Table 1], which is derived from Clause 5.4.3 of IS0 15189:2012. Based on our findings, we proposed changes in the LRFs, to be submitted to the hematology section, along with specimens.
|Table 1: Summary of parameters assessed in evaluation of the laboratory requisition forms analyzed during the study|
Click here to view
| Ethical clearance|| |
The Institutional Ethics Committee of Malla Reddy Institute of Medical Sciences, Hyderabad has approved the Research work proposed to be carried out at Malla Reddy Institute of Medical Sciences, Hyderabad, Date : 4th Feb 2018 with Reference no MRIMC/2018-19/38.
| Results|| |
The results of the study are given in [Table 1]. While the full name of the patients and their identification numbers and gender were given in all the forms, the age was not mentioned in 30.05% of the forms. A clinical diagnosis, so essential for correct evaluation of results generated from the hematology analyzers, was available in only 39.62% of forms received. Clinical history was given in only 0.27% of forms. The doctor's name, so necessary for communication of laboratory results, was written in only 8.47% of LRFs, and contact telephone number of the doctor in only 0.27% of LRFs. The date and time of sample collection were given in only 0.27% of LRFs.
An analysis of the LRF presently in use revealed that there were no columns available for filling in the clinical history of the patient or the referring doctor's telephone number [Figure 1]. Neither was there a column for filling in the patient's contact details nor the date and time of sample collection and sample receipt.
|Figure 1: Existing laboratory requisition form in use in Malla Reddy Hospital|
Click here to view
| Discussion|| |
Laboratory tests form the cornerstone of proper clinical management of patients in any hospital. The three phases of laboratory sample testing, the preanalytical, analytical, and postanalytical phases, are all crucial to the delivery of accurate and timely results to patients and treating clinicians. Evidence shows that as much as 50%–70% of laboratory errors occur in the preanalytical phase and involve the handling of the LRF. Insufficient information or omission of information on the LRF may lead to laboratory errors, as well as make result interpretation difficult and delay communications with the requesting physician, more so in patients with life-threatening medical conditions. Misidentification of either the patient or the requested test has also been encountered frequently. The LRF not only provides information about the laboratory test being requested but is also used to communicate results back to physicians and patients. The standard LRF contains demographic data and other information, such as the location of the patient, laboratory information, physician's name and signature, telephone number of the requesting physician, and among others. Preanalytical errors, such as the absence of important clinical information on LRF, can have serious effects on patient care by causing postanalytical errors, such as inappropriate interpretative comments.
Our study revealed that the majority of the LRFs received in the hematology section of the Central Laboratory of Malla Reddy Hospital were incompletely filled, with clinical diagnosis available in only 39.62% of cases and doctor's name in only 8.47% of LRFs. In contrast, Jegede et al. found that the doctor's name was filled in 90.1% of cases. The clinical diagnosis was available in 99.8% of the laboratory forms in their study. Zemlin et al. reported that the doctor's name was available in 65.2% of the LRF in their study. An Australian study revealed that 43% of forms lacked complete information; missing items included doctor's name. Clinical diagnosis was available in 77% of cases in a study in Nepal and 39% in a study in India by Chillar et al. Almost all studies revealed that, like in our analysis, patient details and examination request were correctly filled in 100% of the forms submitted with the samples. The degree of completeness of laboratory forms in our study was much below that seen in other studies.
Most studies have revealed that the reason for incomplete filling of LRF is inadequate awareness of clinicians regarding the significance of adequately filled LRF in the context of the preanalytical phase of the TTP [Figure 1].
| Conclusion|| |
Our study has shown that incompletely filled LRF is a major cause of error in the preanalytical phase of the TTP. Our analysis of the LRF available in its present form suggested that a revised format for an LRF which has adequate columns for filling in all the desired details in the LRF as per ISO 15189:2012 needs to be developed. We have developed a new format for the LRF, which is attached in [Appendix 1]. There is also a need for sensitizing the clinicians at all levels regarding the importance of the preanalytical phase of TTP and the crucial role that the LRF plays in helping the pathologist to provide meaningful information to the clinicians and patients based on the correct interpretation of laboratory testing results.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Harrison JP, McDowell GM. The role of laboratory information systems in healthcare quality improvement. Int J Health Care Qual Assur 2008;21:679-91.
Kristensen GB, Aakre KM, Kristoffersen AH, Sandberg S. How to conduct External Quality Assessment Schemes for the pre-analytical phase? Biochem Med (Zagreb) 2014;24:114-22.
Carraro P, Plebani M. Errors in a stat laboratory: Types and frequencies 10 years later. Clin Chem 2007;53:1338-42.
Najat D. Prevalence of pre-analytical errors in clinical chemistry diagnostic labs in Sulaimani City of Iraqi Kurdistan. PLoS One 2017;12:e0170211.
Cornes MP, Atherton J, Pourmahram G, Borthwick H, Kyle B, West J, et al
. Monitoring and reporting of preanalytical errors in laboratory medicine: The UK situation. Ann Clin Biochem 2016;53:279-84.
Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff (Millwood) 2010;29:1310-8.
Adegoke OA, Idowu AA, Jeje OA. Incomplete laboratory request forms as a contributory factor to preanalytical errors in a Nigeria teaching hospital. Afr J Biochem Res 2011;5:82-5.
Nwachukwu N, Onyeagba R, Obikwe V, Nwoka C. Incompletely filled data on laboratory request forms as a source of pre–analytical error in a Nigerian specialist hospital. Br J Bio Med Res 2018;2:252-6.
Plebani M, Sciacovelli L, Aita A, Chiozza ML. Harmonization of pre-analytical quality indicators. Biochem Med (Zagreb) 2014;24:105-13.
Burnett L, Chesher D, Mudaliar Y. Improving the quality of information on pathology request forms. Ann Clin Biochem 2004;41:53-6.
Zemlin AE, Nutt L, Burgess LJ, Eiman F, Erasmus RT. Potential for medical error: Incorrectly completed request forms for thyroid function tests limit pathologists' advice to clinicians. S Afr Med J 2009;99:668-71.
Jegede F, Mbah HA, Dakata A, Gwarzo DH, Abdulrahman SA, Kuliya-Gwarzo A. Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria. Afr J Lab Med 2016;5:381.
Gyawali P, Shrestha RK, Bhattarai P, Raut BK, Aryal M, Malla SS. Evaluation of pre-analytical errors: Inadequacies in the completion of laboratory requisition forms. J Nepal Association Med Laboratory Sci 2012;11:43-8.
Chhillar N, Khurana S, Agarwal R, Singh NK. Effect of pre-analytical errors on quality of laboratory medicine at a neuropsychiatry institute in North India. Indian J Clin Biochem 2011;26:46-9.