Where errors happen
Lab errors are usually grouped into three phases: pre-analytical (before testing), analytical (during testing), and post-analytical (after testing). In day-to-day lab work, the pre- and post-analytical phases are where manual handling, and therefore most manual errors, are concentrated.
| Phase | Typical errors | Controls that help |
|---|---|---|
| Registration | Wrong patient details, wrong test ordered | Search existing patients before creating new ones; read back tests to the patient |
| Collection and labelling | Mislabelled or unlabelled sample, wrong tube | Barcode labels printed at registration and applied at collection |
| Analysis | Analyzer fault, expired reagent, missed QC | Daily QC records, reagent tracking, rerun rules |
| Result entry | Typing errors, wrong units, values entered for the wrong patient | Analyzer interfacing or barcode-matched entry; range checks |
| Report and release | Wrong reference range, released without review | Standard templates; approval required before release |
| Delivery | Report sent to the wrong number | Use the registered contact; confirm details at registration |
Remove re-entry wherever possible
Each time the same value is copied from one place to another, from a requisition slip to a register, from an analyzer printout to a report, there is a chance of a typing error. Register once and let every later step use that record. Where volume allows, interface analyzers so results flow directly into the report.
Let the system catch what people miss
Busy staff make mistakes no matter how careful they are. Build checks into the workflow so errors are caught before the report goes out.
- Flag results outside reference ranges and physiologically impossible values
- Auto-calculate derived values (such as LDL or eGFR) instead of calculating by hand
- Require pathologist approval before any report is released
- Highlight large changes from the patient's previous result for review
- Prevent releasing a report with missing mandatory parameters
Standardize templates and reference ranges
Different staff using slightly different report formats or old reference ranges is a quiet source of error. Keep one approved template per test, with reference ranges by age and sex where relevant, and control who can change them.
Close the loop with a correction log
Record every amended report: what was wrong, at which stage, and why. Review the log monthly. If the same error appears three times, fix the process or the template that allows it, rather than reminding staff to be careful.