COMPARISON OF INCIDENCE OF PRE-ANALYTICAL PHASE ERRORS IN OPD AND IPD SAMPLES IN A SUPER-SPECIALTY HOSPITAL: A RETROSPECTIVE STUDY

Gurpreet Singh Battu, Amitoj Singh Battu and Sumeet Sidhu ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 01 September 2020 Final Accepted: 05 October 2020 Published: November 2020


Material and Methods:-
The present study was conducted retrospectively at a super specialty hospital during the period July 2019 to June 2020.
Blood samplecollection for biochemistry tests was divided into OPD and IPD. OPD samples were collected at one single point, sample collection room. IPD samples were collected from different inpatient areas of the hospital. IPD samples were collected by the staff deputed in their respective areas. All the staff were trained in the processes of phlebotomy and were made familiar with color coding of vacutainers.
All the samples were labelled with -patient name and unique hospital ID number [UHID] -for identification. Same were also mentioned on the requisition slip accompanying the sample. Additional data on requisition slip included list of lab tests to be performed, demographic data of the patient, diagnosis and other relevant information.
Following errors were noted, if present, at various stages of analysis: Numberof errors in various categories were noted separately for OPD and IPD patients were compared statistically.

Results:-
A total of 50713 samples were collected on OPD basis during the study period and out of these 679 (1.3%) samples were found to have errors in one of the defined categories. Distribution of errors in OPD was as per When compared statistically, incidence of preanalytical errors in IPD samples was significantly higher than OPD samples.
OPD samples had overall rate of preanalytical errors of 1.3%. Most common error was incomplete requisition form or form with errors. This constituted 50.5% of total errors. Next common error, 24.9% of total, was incomplete label on container. This was followed by incorrect quantity of sample and constituted 16.8%. 4.3% samples were hemolysed, 2.9% were in wrong container and 0.6% had fluid mixed in them.
Preanalytical phase error incidence was 1.7% in IPD samples. Most common error,34.1%, in IPD samples was incomplete of error prone requisition form. 20.5% samples had incomplete label on the container. 15.6% samples were mixed with intravenous fluids. Inadequate quantity was found in 15.3% samples, 9.1% samples were hemolysed and 5.5% samples were dispatched in wrong container.

Discussion:-
A lot of emphasis is being placed on pre analytical phase errors in a biochemistry lab. It is this phase that has the maximum human involvement and maximum variables that can lead to errors. This study was devised to compare the incidence of pre analytical phase errors in OPD and IPD samples.
Results indicate that there is statistically significant higher rate of errors in IPD samples as compared to OPD samples. This finding can be attributed to the fact that OPD sample collection center is manned by same team of lab technicians and are basically extension of lab team. Same team doing the same job full time results in lesser errors. IPD samples are collected from different areas of the hospital. These samples are collected by nursing staff or resident doctors and are just a part of their vast job responsibilities. Hence, the chances of error are more.
Results in Lee NY study showed that 97.6% errors in preanalytical phase occurred in IPD samples as compared to 2.4% in OPD samples. [3]. The difference was statistically significant, a finding similar to present study.
Singh K, Singh AK had similar findingsin their study. [4]. Percentage of preanalytical phase errors in OPD samples was 0.6 as compared to a figure of 2.2% in IPD samples. They suggested the same reason for the difference -same team of phlebotomists in the OPD as compared to different team members in IPD who are not trained in lab practices.
In the study conducted by Patel K, incidence of errors in preanalytical phase in OPD samples was 1.4% as compared to 2.05% in IPD samples. [5]. As a remedy, it was suggested to establish excellent communication and cooperation amongst all the stakeholders including the person collecting the sample and lab staff. Bandyopadhyay D, Mukherjee K, Banerjee S in their study found preanalytical phaseerrorsto the tune of 93.6 per thousand in OPD samples as compared to 141.8 per thousand in IPD samples. [6]. This finding of more errors in IPD samples is same as the present study.
Arul P, Pushparaj M, Pandian K, Chennimalai L et al in a similar study found frequency of preanalytical phase errors to be 0.35% in OPD samples as compared to 0.52% in IPD samples. [7]. They attributed higher frequency of errors in IPD samples to the fact that many of IPD staff involved in sample collection were not aware of the importance of proper techniques.
Bharat V, Tiwari G, Bansal R and Gupta BK in their study recorded 1.4% (510 out of 36200) preanalytical phase errors in OPD samples and 3.75% (1080 out of 28800) in IPD samples. [8]. Preanalytical phase errors were seen