Problematic Specimens in an Academic Clinical Microbiology Laboratory: A Pilot Quality Assurance Study

Abstract

The accuracy of specimen identification and the assurance of appropriate specimen collection are extremely critical as reporting a wrong laboratory test result can have potentially devastating effects on patient care. However, "problematic specimens," such as mislabeled/unlabeled specimens or specimens collected in wrong media/container are not uncommonly seen in clinical microbiology laboratories. The goal of this pilot study is to investigate the types and sources of microbiology specimen errors in a large tertiary teaching hospital. A retrospective microbiology laboratory specimen data review (01/2012-05/2012) was performed to retrieve all problematic specimens , which were classified as: mislabeled or unlabeled specimens, specimens collected in the wrong media/containers, specimens with quantity not sufficient (QNS), specimen sent for unavailable tests, duplicate order specimens and clerical errors. In addition, the hospital locations of the specimens, such as intensive care unit (ICU), wards, outpatient office, etc were identified. Furthermore, the specimen types (blood, urine, stool, body fluid, etc) and requested tests (blood culture, urine culture, stool culture, etc) were categorized and analyzed. Ninety-two problematic specimens (0.2% of total 47,787 specimens) were found within 5 months in our academic clinical microbiology laboratory. Of these, specimens with mislabeling (28/92, 30.4%) and collected in the wrong media/container (20/92, 21.7%) were most frequently seen. Of note, the medical ward constituted the most problematic specimens (38/92, 41.3%) while the ICU ranked second (21/92, 22.2%). The most common problematic specimen type was body fluid (18/84, 21.4%), followed by urine, stool, and sputum with equal number (15/84, 17.8%). In terms of the requested tests, urine culture (15/81, 18.5%) was the most common problematic test requested. Finally, most of the incorrect specimens were rejected (51/92, 55.4%) or corrected by clinical staff (20/92, 21.7%). Our study indicated that ongoing specimen submission education for clinical and nursing staffs is warranted and necessary for optimal patient care.