The Right Specimen
The New York Times reports that a laboratory sent letters to nearly a thousand patients for redraws after six patient samples on six specific days in a nine-month period were discovered as mislabeled. A hospital spokesman describes them as "isolated incidents," although he points out that medical errors are a widespread problem.
Most patients have no idea what happens to a blood sample after it's drawn. Neither do we, when a sample is sent to a referral laboratory. But all laboratories have rigorous identification and labeling standards that are religiously followed at the time of draw. Laboratories treat errors seriously and deviations as near misses. It's part of the culture.
It can be a challenge to get non-laboratory professionals to appreciate the value of these standards. Specimens dropped off may be unlabeled, labeled for the wrong patient, or labeled with incorrect information i.e. wrong culture site. It can be frustrating for the doctor or nurse to hear a specimen will be rejected when they may have just been at the patient's bedside. What's the big deal? I know my patient. Your laboratory may have variations on this policy to account for unique situations.
We can imagine how these errors happen. Patient wristbands are not checked before collection or are absent. Specimens are pre-labeled, handed off, dropped off, or stuck in pockets. Specimens from different patients are labeled at the same time. A common root cause is not immediately labeling a specimen in the presence of the patient.
A strict rejection policy enforces compliance but may not fix root causes. The laboratory can train collectors, draft policies, educate staff, and directly observe performance. Cheat sheets and posters that show what to draw and how to label are helpful tools. And monitoring and reporting errors to a hospital quality improvement committee can show how these initiatives succeed.
To a patient, the lab not having the right specimen is frightening. It frightens us, too.