NQF endorses practices for safe lab medicine: focus is on processes that occur before, after testing.

The National Quality Forum (NQF) has endorsed a set of practices to improve the safety and quality of laboratory services. Past quality improvement efforts, notes the NQF, have focused on the analytic phases of laboratory testing, but very little quality improvement has focused on the pre-analytic and post-analytic phases of laboratory testing. The need for such a focus is clear, says the NQF, because "evidence indicates that errors occur during this time at uncommonly high rates--pre-testing error rates are as high as 75%, and post-testing error rates are as high as 31%."

"One example of a pre-testing error would be a specimen mix-up," offers Paul Valenstein, MD, director of clinical microbiology and quality management at Saint Joseph's Mercy Hospital in Ann Arbor, MI, and co-chair of the steering committee that enumerated these practices. "We perform a perfect analysis with an extremely accurate result, and it's on the wrong patient because the tube was mislabeled."

An example of a post-analytic error, says Valenstein, would be having a urine culture result become available after the patient has been discharged. "The report goes to the hospitalist, who ignores it because the patient has been discharged, and the outside physician never sees it," Valenstein suggests. "Again, you have a perfectly good result--not going to the caregiver who needs it." Avoiding such errors, he says, "is all about communication and defining expectations--inputs and outputs."

The newly endorsed practices focus on communication and safety specifically within these areas and are intended to help labs adopt a more standardized approach for pre- and post-testing and thus provide safer and higher-quality care. The practices are:

1. Laboratory Leadership--Leaders of organizations that participate in test ordering and leaders of clinical laboratories should collaboratively ensure that specific expectations regarding communication to and from the laboratory are met.

2. Patient/Specimen Identification--Standardized policies, processes, and systems should be implemented to ensure the accurate and legible labeling of laboratory specimens.

3. Sample Acceptability--Collection and processing facilities should ensure that acceptable specimens are collected using appropriate techniques.