(P-TS-81) Potential for Errors with Specimen Send Outs

As staffing shortages impact testing, transfusion services must make choices. Do we retain certain testing in-house or consider other options?  Previously, sending samples to the reference lab (RL) was the ideal option. There were those assays that were challenging and better left in the hands of dedicated blood bank specialists or where competency was not ideal due to less frequently performed assays. What about other situations where hospitals were asked to reduce cost, especially regarding the expenditure of send out cost impacted with additional courier or stat fees? Other considerations that may impact decisions include potential for transcription errors when logging specimens for pick up, HIPAA violations by not protecting the patient information during courier transport, biohazard exposure for untrained couriers or specimen integrity with temperature fluctuations during transport must also be considered. This was a review of opportunities associated with potential for error (PFE) when processing a sample to send to a RL vs. retaining the sample in-house.

Study

Design/Methods:

Our facility reviewed the current processes within our lab and those opportunities for error outside of our facility. This included review of logs, documentation, and observations. Each step was recorded and reviewed internally, with our courier, and reference lab to ensure all processes were included.

Results/Findings:

 We found based on our send out procedure that there were numerous potentials for errors (Table 1). This included PFE opportunities: Specimen at Hospital (3), Transit (4), Specimen at RL (3), RL Sending Results (3), and Hospital Result Entry (2). Total Potential for Error when sending a sample to the RL was fifteen (15). This did not include any actual PFE occurring in the RL testing but the process to get the sample to them and the results back to the facility.  In 2023, we sent 11 specimens to the RL resulting in 165 PFE. 

Conclusions:

There are times when the reference lab is the best option to complete specialized testing. This includes complicated sample workups, difficulty maintaining competency with staff, or when experienced staff are not available in-house. During 2023, our potential for send out errors was 165 as we realized there are other factors besides longer turnaround times and cost when sending a specimen out. The potential for error is always something that must be balanced and considered when determining the best patient care.  Is this an assay we can do in-house, or should we start considering that some assays are well within our capabilities, even if we only offer them during certain shifts, to reduce PFE, improve turnaround times, and reduce our send out cost? Ultimately, it depends on what will help our staff and give the best patient care.