Reducing the Preanalytical Phase Errors in Medical Laboratories: A Quality Improvement Project Protocol

Abstract

Abstract Introduction: In a medical laboratory, the main role is to ensure that the test results produced are accurate, reliable, timely, and reproducible to help clinical decision making. The problem that the project is seeking to address is related to the high rate of preanalytical errors in clinical laboratories. There are three phases of operations in a medical laboratory that are the pre-analytic phase, the analytic phase, and post-analytic phase. Errors have been reported across all three phases in medical labs. The phase with the highest error rate is the pre-analytic phase. This research project delved into the problem of preanalytical phase errors in medical laboratories and how they can be reduced. Objectives: The research project aims to investigate the high rate of preanalytical errors in medical laboratories, find possible strategies to reduce these errors with a specific focus on Lean and Six Sigma strategies and design a plan on how to implement these strategies. The main objectives included to analyse the causes of preanalytical phase errors in medical laboratories based on the latest research evidence, to analyse all available strategies to reduce preanalytical phase errors in medical laboratories and to analyse how Lean and Six Sigma strategies help to reduce preanalytical phase errors in medical laboratories. Methods: The study utilised a database search from relevant databases including primarily PubMed, Medline, CINAHL, EMBASE, NHS Evidence, Scopus, and COCHRANE, and other sources such as Google Scholar, DOAJ, ScienceDirect and ResearchGate to add to more literature. Using the PICO framework to formulate the question and CASP appraisal framework, relevant studies were extracted and analysed. Findings: Findings identified four main themes that focused on causes of preanalytical errors, outcome measures, interventions used to reduce preanalytical errors, and effectiveness of lean and six sigma strategies in reducing preanalytical errors. The findings also seem to indicate that Lean and Six Sigma methods are effective in reducing preanalytical errors in laboratories across hospitals with resource capable as well as resource-limited areas. Conclusion: While a comparison of the effectiveness in reducing PA errors between Lean Six Sigma strategies to other strategies was difficult because of the lack of standardised quality indicators and metrics, there were useful findings that indicated Lean and Six-Sigma were effective due to reduction in error rate. Therefore, use of the method in quality improvement projects to reduce the preanalytical phase error rate in clinical laboratories is recommended.