Reasons for a Laboratory’s Inability to Report Results for Requested Analytical Tests

Abstract

There is increasing understanding concerning the importance of the preanalytical circumstances on laboratory quality, including failures to report requested results. In the past, why the laboratory was unable to deliver a result was not investigated. Accordingly, when looking into the computer system for discrepancies between number of tests requested and number of tests reported, only the volume of this serious quality problem but not the reasons could be seen. Knowledge of the most frequently occurring reasons for report failure is essential in the process of continuous quality improvement. Previous papers have focused on the total number of report failures, and numbers from 0.1% to 2.0% have been published (1)(2)(3). Ideally the number of unanswered test requests should be zero. In real life it is not possible to fulfill this quality demand, and a practical standard or quality goal concerning this number has not been agreed on, although some authors have suggested 0.2–0.5% (4)(5) as being possible and realistic. We have studied the reasons for failure to report results in our 600-bed hospital, which serves an area with 120 000 persons and 90 general practitioners. Both general practitioners and hospital wards use request forms with a combination of bar codes and optical mark reading, ensuring that the data system receives key information, including the patient’s unique national identification, the requesting doctor’s identification, tests requested, and a request form number. The tubes are labeled at the time of sample collection with the bar code label attached to the request form. When a sample is not received with a request form, the reason is investigated and recorded in the computer. Similarly, at all phases of the analytical procedure, beginning at the patient contact, the reason is recorded for any inability to obtain blood, to mail a specimen, …