Everything looks great! Or does it? – How lab errors happen and how they can be minimized

Imagine your client had a routine blood screen ten weeks into her pregnancy, and the results come back clear. Your client rejoices and goes on with her life. However, seven months later, her child is born with a blood disorder that kills him three weeks later. This was the case for C. S., who not only had to handle the devastation of her son’s diagnosis, but was also faced with the reality that the illness could have been treated months ago if it hadn’t been for a careless lab error.1

While we’d all like to believe cases like this are exceedingly rare, when over 70% of clinical decisions are based on laboratory test results, it’s vital to confront their potential inaccuracies.2 A recent study found that the range of laboratory error is between 0.1% and 3.0%.3 Even with a defect rate of 0.1%, when applied to the seven to ten billion tests run every year in the U.S., that’s seven to ten million patients affected.4 Medical testing requires communication between medical professionals, attention to detail, and properly functioning technology for accuracy. Unfortunately it appears that it might be falling short.

To help understand the obstacles individuals could be facing from the possible poor lab practices, here is an insightful overview of the phenomenon:

What’s going wrong?

There are three stages in the testing process – pre-analytical, analytical, and post-analytical – and though errors can arise at any stage, between 46% and 68.2% of errors are observed in the pre-analytical phase.5 This is before the physical act of testing even begins, meaning technical failures are less at fault, and human negligence is more to blame. One of the main culprits here is labeling; samples can easily be mislabeled, swapped, or not labeled immediately.6 Additionally, collecting blood samples incorrectly or without awareness of patients’ preexisting conditions are small mistakes that can have enormous consequences.7

Perhaps more serious than the pre-analytical mistakes, though, are the errors that occur when regulations are not abided by in the laboratory where the testing takes place. Often, to cut costs, basic safety measures are not followed. For instance, control samples, which have known values and can be expensive, are used less.8 Similarly, the Milwaukee Journal Sentinel discovered that labs were using expired products to screen for cancer and test children for lead poisoning.9 Beyond frugality, certain standards were not kept up in regards to cleanliness and machine functionality. Instruments get dirty if not cleaned routinely; pumps inside machinery break down if not maintained; machines must be calibrated for proper results; blood needs to be kept cold before a transfusion; compounds deteriorate over time if not stored properly.10 If lab technicians and managers don’t follow basic protocol, even due to simple forgetfulness, the costs can be devastating.

How can lab errors be prevented?

Many problems in how lab samples are treated can be easily eliminated simply through better communication among team members. There should be close coordination between the specimen management team, the clinician ordering the test, the phlebotomist, the courier picking up the specimen, and the lab technicians processing the specimen.11 This can help assure that each professional has the proper knowledge to label and test the specimen correctly. In a similar vein, all employees should be offered continued phlebotomy education to keep them up to date on recent developments in error reduction.12

To decrease many of the pre-analysis errors that occur, checking and double-checking cannot be stressed enough. While using technology like bar-coded wristbands and biometric scanning (such as with fingerprints or the iris) can be extremely effective, the usage of two patient identifiers can be all that is needed.13 Requisitions should be checked against results. Specimen containers should be labeled immediately after specimen collection. Machines should be routinely checked and tools cleaned thoroughly. Additionally, all labs should have written procedures posted explaining every step of identification, collection, transport, and preparation for analysis.14 If these criteria are followed closely, and each specimen is recorded in a log book, the risk for error will be significantly minimized.

What to remember:

Lab errors have long been a problem in the medical world. However, over the last decade, there is a new willingness to recognize human error not as inevitable, but as something that can be improved upon. Every patient deserves to have their tests carried out as safely and carefully as possible, and this acknowledgement has helped health care organizations actively work to prevent error incidence.15 Knowing the causes and potential remedies of lab errors helps medical specialists improve their practices, helps patients assist in the pre-analytical accuracy, and helps the attorney understand the potential risks for litigation.