Mislabeled Specimens Research Articles

Utilizing Clinical Microsystems to Improve Mislabeled Specimen Occurrences in the Emergency Department

IntroductionMislabeled specimen collection in the emergency department has the potential to significantly harm patients. Studies suggest that improvement efforts can reduce specimen rejection from the laboratory and reduce mislabeled specimens in emergency departments and hospital-wide. MethodsThe clinical microsystems approach was used to understand the problem of mislabeled specimens in an emergency department that is part of a 133-bed community hospital in Pennsylvania. Plan-Do-Study-Act cycles were implemented with the help of a clinical microsystems coach. ResultsSignificant reductions in mislabeled specimen collection were observed over the study period (P < .05). Sustainable improvements were achieved over the >3 years since the improvement initiative began in September 2019. DiscussionImproving patient safety in complex clinical settings requires a systems approach. Using the established framework of clinical microsystems, along with a tenacious and persistent interdisciplinary team, helped create a reliable process for minimizing mislabeled specimens in the emergency department.

Effect of Pre-Analytical Errors in Laboratory Testing Facilities: The Way Forward

Pre-analytical errors contribute a significant proportion of errors of all major sources of mistakes made in laboratory testing processes and are responsible for several patient safety risks. It contributes to wrong therapeutic interventions, irrelevant follow up laboratory investigations and diagnostic delays, which impact negatively on the economy and laboratory effectiveness of health services. Pre-analytical phase is directly related to the procedure of specimen collection and is mostly out of the direct control of the laboratory; further, most pre-analytical errors are related to human factors. The aim of the study is to determine the nature and the occurrence of pre-analytical errors and recommendations on possible measures to reduce these errors. A total of 300 specimens were randomly sampled from a study population of 600 patients and analyzed for pre-analytical errors. One hundred and eighty-four (184) samples were found unsuitable for further processing accounting for 1.9% of all samples analyzed for pre-analytical errors and sample rejection. Rejections were due to following reasons: hemolysis 21.7 % (40) wrong tubes 19 % (35); clotted blood 17% (32); inappropriate timing of collection 15.7% (29); mislabeled specimens 15.2% (28); insufficient specimen quantity 6.5 % (12) and lipemic specimens 4.3% (8). The overall percentage of rejection was 1.9% and the substantial numbers of the rejected specimens were re-tested. Efforts aimed to reduce the rates of rejected samples can improve the quality of laboratory-based health care response. Keywords: Error, Laboratory, Pre-analytical, Rejection, Specimen.

Continuing Profound Impact of Continued Education Sessions on Blood Bank Specimen Labeling Years Later at the Veteran Affairs Medical Center

Abstract Introduction/Objective Proper patient identification is a critical safety element for transfusion medicine, particularly for the prevention of acute hemolytic transfusion reactions (AHTR). Mislabeled specimens have been documented to carry an increased risk of patient misidentification. Therefore, the submission of a mislabeled specimen to the blood bank generally results in a specimen rejection with a redraw. At the Philadelphia Veteran Affairs Medical Center, an identification bracelet with alphanumeric code is used to help improve transfusion safety but also has additional patient labeling requirements. The redrawing of blood bank specimens poses risks in phlebotomy, and a quality improvement initiative was previously undertaken to educate staff on proper blood specimen and band labeling and usage to prevent labeling errors, improve safety in patient care, and reduce intended redraws. Methods/Case Report Colorful laminated posters delineating the labeling requirements and process for blood bank specimens collected using the blood bank system were made and distributed at the time of in-service training by the blood bank in 2017 to the areas of the hospital whereby errors had been noted to occur in the past. The dedicated in-service training was repeated prior to the change in the identification blood band from the Hollister Ident-ATM Blood Recipient Band (Precision Diagnostics Corporation, Valencia CA) to the Typenex Blood Bands (Typenex Medical, Chicago IL) on 11/12/2019. As part of the quality metrics of the blood bank, blood bank specimen labeling errors was tracked from 2017 to track the persistence of the effect of the initial training. Results (if a Case Study enter NA) The percentage of properly labeled specimens as a percentage of total specimens increased after the in-service training; specifically, an increase from a low of 97% (December 2017) to a high of 99% (August 2018). The percentage of properly labeled specimens remains at the increased level of 99% and above even at the 4.5-year mark in mid-2022. Conclusion The continued availability of laminated educational posters on blood specimen labeling for the clinical service areas combined with initial in-service education can have lasting effects to improve the quality of care even years after the initial in-service education sessions.

Adding Automation and Independent Dual Verification to Reduce Wrong Blood in Tube (WBIT) Events.

Transfusions remain a complicated procedure involving many disciplines performing various steps. Pretransfusion specimen identification errors remain a concern. Over the past two decades, system changes have been made and minimal improvements in the error rates have been seen. Wrong blood in tube (WBIT) events may lead to mistransfusions of components with life-threatening complications. A continuous quality improvement effort involving the introduction of electronic patient identification at the point of pretransfusion specimen collection (an automated system improvement), manual independent dual verification, and periodic education (human process system improvements) were implemented. Both automated and human system process improvements resulted in greater than 10-fold reduction in WBIT events and a 47% reduction in mislabeled specimens. Diligent improvement and implementation of combination automated system processes and human protocols with continuous monitoring led to great reductions in WBIT error rates and labeling discrepancies, leading to an increase in system safety. These combinations of improvement can lead to more decreased error rates if applied to other critical process steps in the transfusion process.

Answering Unanswerable Questions in the Clinical Laboratory with Data Warehouses

Laboratorians face many “unanswerable” questions in their daily work. What caused a false-positive test in this patient, when all the known interferences have been ruled out? How can I identify mislabeled specimens in the laboratory, when all I have are the specimens themselves? Does this patient really need that test? None of these questions is truly unanswerable, of course; rather, the hapless laboratorian must hazard a guess for each question, based on limited time and information, then move on to the next question. With more data and analysis, perhaps a more satisfying answer would have been possible. The more fundamental question, though, is why don't we have easy access to that data? In many situations, we are tantalizingly close. In this issue of Clinical Chemistry , Hughey and Colby present the results of a study aimed at identifying previously unknown sources of cross-reactivity in urine drug screening immunoassays (1). By leveraging their own institution's electronic health record (EHR)2 system, they obtained 698651 individual assay results from 40741 patients and linked them to medication exposures documented in each patient's chart. Using logistic regression on 2201 assay–ingredient pairs, they were able to identify several new sources of cross-reactivity, which were validated experimentally. These results provide immediately actionable information for future testing, both to help decipher false-positive drug screen results and to add additional medications to a list of potential cross-reacting substances. Such large retrospective observational studies, involving thousands of patients scattered across an institution, could not be possible without access to and effective use of EHR data. Unfortunately, because the primary purpose of EHRs is to facilitate individual patients' care, the means to answer broader questions that affect many patients or groups of patients may be elusive to clinical providers and laboratorians alike. When randomized controlled trials and other well-designed studies …

Frequency of Mislabeled Specimen in a Histopathology Laboratory

Background: Mislabeled specimens are one of the most common pre-analytic errors in a histopathology laboratory. As histopathology provides the final diagnosis for most of the diseases, labeling errors can lead to serious consequences leading to wrong treatments.&#x0D; Objectives: This study was carried out to find common pre-analytical errors of histopathology laboratory in the context of our country.&#x0D; Methods: Data were collected on six points of container labeling and nine points of requisition papers through simple check list over a period of one week.&#x0D; Results: Among 142 samples, labeling was found in 82.40% container. Among these labels, patients name, age, hospital registration number of the patients were absent in 19.01%, 26.06% and 90.85% samples respectively. Site of origin of the tissue in the container was absent in 71.83% samples. About 4.93% samples came to the laboratory without fixatives. Patients name, age, sex, site of origin of tissue, name of the referring physician and their contact numbers were found absent in 0.70%, 3.52%, 33.10%, 7.75%, 50% and 95.77% of requisition papers respectively. Clinical diagnosis was absent in 54.23% cases. A good proportion of container and requisition papers did not contain proper labeling, which is important not only for identification but also for histopathological diagnosis.&#x0D; Conclusion: We believe that, these errors occur due to lack of standard histopathology requisition form. Association of Surgeons and Pathologists can collaboratively form a standard requisition form for sending histopathology samples to different laboratories, which could easily reduce mislabeling errors in histopathology.&#x0D; Journal of Surgical Sciences (2013) Vol. 17 (2) :80-83

Plant or animal, terrestrial or marine? Thoughts on specimen curation in university palaeontological teaching collections based on an example from Ohio, USA

Palaeontological teaching collections at universities are critical to accurately con- veying aspects of palaeobiology and palaeoecology to students who, in turn, may eventually disseminate that information to the general public via a variety of museum-related pathways. Unfortunately, curatorial rigor is often less strongly rein- forced in university teaching collections than in museum collections, leading to unlabeled or mislabeled specimens, or specimens grouped into collections with an excessive amount of missing data. Herein I describe one illustrative example of confounding specimen labeling from the palaeontological teaching collections of the University of Akron Department of Geosciences (Akron, Ohio, USA). The studied specimen represents a portion of the distinctive stem of the common Upper Carboniferous sphenopsid plant Calamites, but is labeled as the stem of a crinoid (Phylum Echinodermata). Thus, a land plant has been attributed to a portion of a marine invertebrate, a misidentification that transcends not only biological king- doms but also the continental-marine discrepancy. Aside from major morphological differences between these two organisms, the specimen is preserved in a way that is nearly impossible for crinoid columns but is relatively common for Calamites. This find illustrates a major potential source of confusion or misinformation among palaeontology students (and future museum workers) and highlights the significance of scrutiny in teaching collections in addition to museum collections. Individuals working with teaching collections inherited from a predecessor or consisting of organisms with which they are relatively unfamiliar are encouraged to contact a specialist for consultation, identification and correction.

Effectiveness of Specimen Collection Technology in the Reduction of Collection Turnaround Time and Mislabeled Specimens in Emergency, Medical-Surgical, Critical Care, and Maternal Child Health Departments.

The objective of this study was to evaluate the impact of specimen collection technology implementation featuring computerized provider order entry, positive patient identification, bedside specimen label printing, and barcode scanning on the reduction of mislabeled specimens and collection turnaround times in the emergency, medical-surgical, critical care, and maternal child health departments at a community teaching hospital. A quantitative analysis of a nonrandomized, pre-post intervention study design evaluated the statistical significance of reduction of mislabeled specimen percentages and collection turnaround times affected by the implementation of specimen collection technology. Mislabeled specimen percentages in all areas decreased from an average of 0.020% preimplementation to an average of 0.003% postimplementation, with a P < .001. Collection turnaround times longer than 60 minutes decreased after the implementation of specimen collection technology by an average of 27%, with a P < .001. Specimen collection and identification errors are a significant problem in healthcare, contributing to incorrect diagnoses, delayed care, lack of essential treatments, and patient injury or death. Collection errors can also contribute to an increased length of stay, increased healthcare costs, and decreased patient satisfaction. Specimen collection technology has structures in place to prevent collection errors and improve the overall efficiency of the specimen collection process.

Labeling tubes before collection threatens patient safety

Blood specimen identification errors continue to threaten patient safety. One study reviewed 4.29 million specimens collected over 24 months and found the frequency of mislabeled specimens, unlabeled specimens, and specimen-requisition mismatches to be 1.0%, 4.6%, and 6.3%, respectively, with mislabeling presenting the greatest danger (1).

360 Specimen Collection and Labeling After Implementation of New Electronic Health Record: Work as Imagined Versus Work as Performed

New electronic health record (EHR) systems are often designed without usability testing of work as imagined versus work as performed. In response to low adoption (63%) of a newly implemented EHR barcode specimen collection system in an emergency department (ED) setting, we investigated the barriers to successful use. We performed a multistep task analysis of ED specimen collection workflow at two urban EDs following human factors theory. We directly observed nurses doing their work during 30 observation sessions and interviewed 22 nurses about why they did their work in the way that it was observed. An interdisciplinary team classified potential patient safety vulnerabilities and prioritized mitigation strategies according to the Socio-Technical System Hierarchy of Intervention Effectiveness. We identified 12 barriers to use of the new EHR system. Two dominant deviations from work as imagined were observed: 1) using the paper pre-EHR form and, 2) scanning Admission/Discharge/Transfer (ADT) labels instead of patient wristbands. These workarounds most often occurred in three scenarios: 1) when scanning equipment was unavailable (eg, hallway patient), 2) strict time constraints were in place (eg, during trauma activations), or 3) when nurses saw patients before providers and initiated an IV and blood draws prior to orders. The alternate workflows have the potential for misidentification and mislabeled specimens. Three recommendation categories were prioritized: additional equipment, IT/programming fixes, and creation of workflow protocols. The low compliance rate with the new specimen collection system was understandable and predictable when frontline providers were observed performing the work in their environment. The recommendations provided present opportunities for EDs to improve the processes surrounding the use of specimen collection systems. The methods described in this project could be employed in health care settings to proactively examine new systems and identify and address the corresponding work process challenges. Usability testing of new EHR systems should be performed in the environments in which they will be used prior to implementation in order to minimize both workflow disruption and patient safety threats.

Subgeneric classification and biology of the leafcutter and dauber bees (genus Megachile Latreille) of the western Palearctic (Hymenoptera, Apoidea, Megachilidae)

A new identification key is presented for the western Palearctic subgenera of the bee genus Megachile. In addition, the species composition of each subgenus is discussed, and for large subgenera, species groups are delineated to facilitate future taxonomic treatment. The nesting biology and floral associations of each subgenus are briefly reviewed. Lectotypes are designated for Megachile albocincta Radoszkowski, M. genalis Morawitz, M. hirsuta Morawitz, M. inornata Walker, M. luteipennis Friese, M. mandibularis Morawitz, M. melanogaster Eversmann, M. orientalis Morawitz, M. picicornis Morawitz, M. pilicrus Morawitz, M. sedilloti Pérez, M. thevestensis Ferton, M. vestita Giraud (=M. giraudi Gerstäcker) and M. villipes Morawitz. In addition, the following taxonomic changes are proposed: the subgenus Paracella is synonymized with the subgenus Anodonteutricharaea (syn. n.); three species, Megachile breviceps Friese, M. luteipennis and M. algira Radoszkowski are excluded from the Palearctic fauna as they were likely based on mislabeled specimens; M. luteipennis is newly placed in synonymy with M. dimidiata Smith (syn. n.), and M. algira with M. opposita Smith (syn. n.); M. punctatissima Spinola is considered an incorrect spelling of Stelis punctulatissima (Kirby) and not a valid species-group name. Heriades sinuata Spinola is newly placed in synonymy with H. truncorum (Linnaeus) (syn. n); M. boops Friese is transferred to the genus Hoplitis (comb. n.) and placed in synonymy with Hoplitis tigrina (Morawitz) (syn. n.); M. pyrsa Vachal is transferred to the genus Prodioxys (comb. n.) and placed in synonymy with Prodioxys carnea (Gribodo) (syn. n.); Stelis megachiloides Alfken is transferred to the genus Megachile (comb. n.) and placed in synonymy with M. marginata Smith (syn. n); M. larochei Tkalců and M. lanigera Alfken are placed in synonymy with M. albohirta (Brullé), M. albocincta Radoszkowski with cyanipennis Guérin-Méneville, M. rhodosiaca Rebmann and M. heinrichi (Tkalců) with M. doriae Magretti, M. vicina Morawitz with M. giraudi, M. picicornis Morawitz and M. albocincta Pérez with M. marginata, M. esseniensis (Pasteels) with M. maxillosa Guérin-Méneville, M. sexmaculata Alfken, M. sexmaculata thracia Tkalců and M. pilicrus flavida Zanden with M. melanogaster, M. transitoria Benoist with M. parietina (Geoffroy), M. judaea (Tkalců) with M. pasteelsi (Zanden), M. cyrenaica Schulthess, M. fumosa Alfken and M. fulvocrinita Alfken with M. sedilloti, M. insignis Zanden with M. soikai Benoist, M. mavromoustakisi Zanden with M. troodica Mavromoustakis and M. semipleta Cockerell with M. versicolor Smith (syn. n.). Megachile rhodoleucura Cockerell is reestablished as a valid species (stat. rev.). Megachile posti Mavromoustakis is considered as a valid species (stat. n.) and not as a subspecies of M. basilaris Morawitz. Megachile calloleuca Cockerell is newly placed into the subgenus Megachile, M. inornata, M. thevestensis, M. troodica into the subgenus Anodonteutricharaea, and M. hirsuta, M. pasteelsi into the subgenus Chalicodoma.

Implementation of Epic Beaker Clinical Pathology at Stanford University Medical Center.

To provide an account of implementation of the Epic Beaker 2014 clinical pathology module at Stanford University Medical Center and highlight strengths and weaknesses of the system. Based on a formal selection process, Stanford selected Epic Beaker to replace Sunquest as the clinical laboratory information system (LIS). The rationale included integration between the LIS and already installed Epic electronic medical record (EMR), reduction in the number of systems and interfaces, and positive patient identification (PPID). The build was significantly customized and included a first of its kind Epic-to-Epic interface. This was due to the clinical laboratory serving two hospitals (pediatric and adult) with independent instances of Epic. Test turnaround times showed improvement from historical baselines, mostly because of the implementation of PPID. PPID also resulted in significant reduction in mislabeled specimens. Epic 2014 Beaker clinical pathology is a viable LIS with adequate functionality for a large academic center. Strengths include PPID and integration with the EMR. Integration provides laboratory users with ready access to the patient's relevant clinical history to assist releasing of results and gives physician and nurse providers sophisticated add-on ordering and specimen collection workflows. Areas that could use further development include specimen aliquoting, quality control reporting, and maintenance tools.

Review of the whirligig beetle genus Gyrinus of Venezuela (Coleoptera: Gyrinidae)

The Venezuelan species of the genus Gyrinus Geoffroy, 1762 are reviewed (Gyrinidae: Gyrininae: Gyrinini). The Venezuelan Gyrinus fauna is found to be comprised of nine species distributed among the subgenera Neogyrinus Hatch, 1926 and Oreogyrinus Ochs, 1935, although Gyrinus (Oreogyrinus) colombicus Régimbart, 1883 is known from imprecisely localized and potentially mislabeled specimens and the species presumably does not occur in Venezuela. Three new species are described: G. (Oreogyrinus) vinolentus sp. nov. from the Andes, and G. (Oreogyrinus) iridinus sp. nov. and G. (Neogyrinus) sabanensis sp. nov., from the Guiana Shield region. Two new synonymies are established: G. amazonicus Ochs, 1958 syn. nov. is synonymized with G. guianus Ochs, 1935, and G. racenisi Ochs, 1953 syn. nov. is synonymized with G. ovatus Aubé, 1838. Gyrinus (Oreogyrinus) feminalis Mouchamps, 1957, described from Venezuela from two female syntypes only, is considered as species inquirendum, as the types were not found. For each species a dorsal habitus, illustration of male and female genitalia, and distribution map are provided. A key and checklist for the Venezuelan Gyrinus species is included.

Development and Evaluation of a Logical Delta Check for Identifying Erroneous Blood Count Results in a Tertiary Care Hospital.

Delta checks have been suggested to increase patient safety by identifying preanalytic and analytic errors, including wrong name mislabeling on the sample tube. To implement an effective and practical complete blood cell count (CBC) delta check by optimizing specificity and sensitivity using weighted deltas of multiple parameters. The mean red blood cell volume (MCV) delta (>3.0 fL) check was retrospectively assessed. The composite CBC delta (CCD) test was formulated using serial same-patient CBC data and random interpatient CBCs. The logical delta check (LDC) ignores CCD failures due to platelet change only. The effect of LDC implementation was evaluated. The MCV delta check test recognized only 3 of 6 confessed mislabeled specimens in the initial review period, whereas all were identified using the CCD. The LDC flagged 2% (205 of 13 234) of eligible results, one-third as many as the MCV delta check. The CCD and LDC checks revealed 20 presumed or confirmed mislabeling events, only half of which were caught by the MCV delta check. Thirty-four percent of LDC failures not due to transfusion reflected problematic results, including presumed or confirmed wrongly labeled patient samples (36% of flags for real problems). Implementation of the LDC, requiring immediate verbal feedback to the caregivers, was associated with more retracted erroneous results in patients' medical records. The MCV delta check test was found not to have led to correction of errors in our laboratory due to impractically low specificity and sensitivity. The LDC is a useful tool for identifying preanalytic and analytic specimen problems, including wrong name mislabeling on the sample tube.

On the identity of Melipona torrida Friese (Hymenoptera, Apidae)

On the identity of Melipona torrida Friese (Hymenoptera, Apidae). Melipona marginata var. torrida Friese, 1916, described from three workers putatively collected in Costa Rica, never had its identity properly recognized. Since its original description, no additional specimens have ever been collected in Costa Rica. It is argued here that Melipona torrida was based on mislabeled specimens and corresponds to Melipona marginata obscurior Moure, 1971, a form known only from southern Brazil, Argentina and Paraguay. A lectotype is designated for Melipona torrida and notes on the type material of Melipona marginata obscurior are provided. Other known examples of species described from mislabeled specimens in Friese's Zur Bienenfauna von Costa Rica are discussed. It is pointed out that additional names proposed in this work, based on material from Costa Rica, might turn out to correspond to South American taxa. Also, the date of publication of this Friese's paper is discussed.

The Goblin Spider GenusIschnothyreus(Araneae, Oonopidae) in the New World

ABSTRACT Although originally described from St. Vincent in the Lesser Antilles, the goblin spider genus Ischnothyreus Simon appears to be an Old World taxon that is represented in the New World only by two presumably introduced, pantropical, synanthropic species: I. peltifer (Simon) and I. velox Jackson. Two specific names based on New World specimens (I. barrowsi Chamberlin and Ivie from Florida, and I. indressus Chickering from the Lesser Antilles) are placed as junior synonyms of I. velox, which is newly recorded from Mexico, Panama, Jamaica, Hispaniola, Venezuela, Brazil, Madagascar, the Philippines, the Marshall Islands, Hawaii, the Marquesas Islands, and New Caledonia. A third species, I. browni Chickering, that is supposedly from Costa Rica was apparently based on mislabeled specimens that are actually from the Philippines. The type specimens of I. browni resemble those of the Seychelle species Ischnothyrella jivani (Benoit) in that the dorsal abdominal scutum of males is extremely weak and that of...

New Coleoptera records from New Brunswick, Canada: Cerambycidae

Five species of Cerambycidae, Acmaeops discoideus (Haldeman), Anelaphus villosus (Fabricius), Phymatodes species (CNC sp. n. #1), Sarosesthes fulminans (Fabricius), and Urgleptus signatus (LeConte) are newly recorded for New Brunswick, Canada. All but Acmaeops villosus are new to the Maritime provinces. Phymatodes testaceus (Linnaeus) is removed from the faunal list of the province as a result of mislabeled specimens, records of Phymatodes maculicollis LeConte are presented confirming the presence of this species in New Brunswick, and the first recent records ofNeospondylis upiformis (Mannerheim) are presented. Additional records are given for the recently recorded Phymatodes aereus (Newman), indicating a wider distribution in the province. Collection data, habitat data, and distribution maps are presented for each species.

Are We Losing the Science of Taxonomy?

To find a reason that the world needs both more taxonomists and better training for them, mammalogist Michael Mares, director of the Sam Noble Oklahoma Museum of Natural History, has only to open a drawer. An authority on the mammals of Argentina, Mares can find specimens relevant to his work in collections all over the world. But more often than not, the labels are incorrect. During one recent visit to a museum that Mares will not name—“but it’s one everyone on this planet has heard of,” he says—he found that every one of roughly 50 specimens, representing seven species and three genera, was mislabeled. And they were all mammals, arguably the easiest life forms to identify. For Mares and a growing chorus of other experts, mislabeled specimens are a symptom of a much larger problem, one that starts with field research, far beyond museum walls. The issue, they say, is that even though our rapidly changing world makes the identification of species increasingly important for biodiversity science— and increasingly relevant to the very future of humankind—the field of taxonomy is underfunded and underappreciated. In the field, it may seem to be only common sense that botanists better trained in plant identification will nitrogen cycling. “Just as the need to catalog, study, manage, and protect species in their environments has never been greater, the pipeline of adequately trained professionals is trickling dry,” concluded a team of Botanical Capacity Assessment Project researchers, led by Marshall Sundberg of Emporia State University. One of the key problems with the training, they note, is the shrinking number of university courses that emphasize plant identification.

Simulations of delta check rule performance to detect specimen mislabeling using historical laboratory data

Background Despite their widespread use, the performance of delta check rules is rarely evaluated because errors are rare and lack a gold standard for detection. In this study we used a simulation-based approach to compare strategies for empirically defining criteria for univariate delta checks, and assessed the performance of these rules for detecting mislabeled specimens in 2 inpatient populations. Methods We performed simulations using historical laboratory test results by randomly sampling pairs of specimens successively drawn from the same patient or two different patients. We evaluated the performance of delta check rules using a variety of thresholds, including those currently in use in our laboratory. Result Mean corpuscular volume had the highest positive predictive value for specimen mislabeling, and produced the fewest false positives. Conversely, rules using other laboratory tests had considerably poorer performance. Several of the “best guess” thresholds historically used in our laboratory, notably those for potassium and anion gap, were predicted to have extremely low yields. In addition, rule performance was not consistent between the two patient populations. Conclusions The low yield of delta checks based on any single analyte should prompt careful evaluation of their practical utility. Furthermore, our results indicate that it may not be possible to generalize delta rules across institutions.

Transforming Care at the Bedside With an Evidenced Based Skills Day Approach

Transforming Care at the Bedside With an Evidenced Based Skills Day Approach