Neil Osterweil

September 19, 2016


LAS VEGAS — Laboratory errors — even seemingly minor ones that occur prior to sample analysis and don't harm the patient — can be costly, according to a review of preanalytic errors.

The average cost associated with a single irretrievably lost specimen was estimated to be $584, and cumulative errors over 3 months cost more than $20,000.

"It's an eye-opener for the staff," said Alia Atwaru, MHA, from Northwell Health and the Hofstra North Shore–LIJ School of Medicine in Hempstead, New York.

"Before, they would say something like, 'yeah, there was a problem and it's going to be fixed', and everyone would move on," she explained.

"They see things differently now, because every level of staffing is involved — from our phlebotomists, to accessionists, technical staff, couriers, and quality-management staff," Atwaru told Medscape Medical News. "Even our executive-management staff is involved, should there be a need to go that far."

She presented findings from the analysis here at the Pathology and Lab Medicine 2016 American Society for Clinical Pathology (ASCP) Annual Meeting.

To get a better handle on just how much seemingly innocuous errors actually cost, Atwaru and her colleagues conducted a retrospective cost analysis associated with the most common errors at Northwell Health Laboratories, a large central core lab and 16 hospital labs that perform more than 19 million billable tests each year. The ultimate goal was to use the information to educate staff about avoiding mistakes in the future.

Avoiding Mistakes

"Some of the most common errors encountered include specimen labeling, improperly collected samples, and missing samples with subsequent redraws due to these errors" report Atwaru and her colleagues.

However, "most laboratory personnel are unaware of the costs associated with poor quality, which may involve redraws, repeat testing, and additional evaluation of results, not to mention client and patient dissatisfaction," they point out. "Every time that work is redone, the cost of laboratory services, the cost of quality, increases."

When calculating average cost, the research team included the number of person-hours associated with correcting the error.

For each error, the resources used could be as little as the few minutes it takes client services staff to notify a client, or it could involve hours of work by quality-management staff. Even when a missing specimen eventually turns up, the cost can be substantial, Atwaru told Medscape Medical News.

"The cost of poor quality may vary from approximately $200 to $2000 per error," the investigators explain, depending on the complexity of the issue, the type of testing, and the level of executive leadership engaged.

Increased awareness about the cost of poor quality appears to be paying off. Although the volume of testing has increased at her center, Atwaru reported, the error rate has not.

It's better patient care to get it right the first time.

These findings are likely to be similar in other laboratories, big and small, said Lee Hilborne, MD, chair of the ASCP effective test utilization subcommittee and a past president of the organization.

"There are clearly direct costs for redraws and similar errors, and there is the cost of what happens to the patient for follow-on testing, even nonlaboratory testing," he told Medscape Medical News. "This study shines a light on just how costly these errors can be."

"This is one center's experience. My guess is that if you did this elsewhere, you might find slightly different numbers, but you would certainly find that it's costly to do the wrong thing. It's better patient care to get it right the first time," he said.

This study was internally funded. Ms Atwaru and Dr Hilborne have disclosed no relevant financial relationships.

Pathology and Lab Medicine 2016 American Society for Clinical Pathology (ASCP) Annual Meeting: Poster LP10. Presented September 14, 2016.


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