From the Field: The Pre-Analytical Phase

The laboratory testing process begins at sample collection and, if successful, culminates with an accurate diagnosis. The March 2019 issue of Diagnosis explores how the collection and testing of the physiologic material, called the pre-analytic stage of the process, must be robust and accurate to generate high-quality data to aid diagnosticians. The issue introduction notes that, as samples are collected outside the controlled environment of the laboratory, poor sample quality has not been recognized sufficiently as a threat to safety. This reality provides context to certain vulnerabilities, including gaps in problem analysis, which have eluded systemized improvement efforts.

Alexander von Meyer of the German Institute for Laboratory Medicine and Microbiology, editor of this special issue, has engaged international contributors to examine the characteristics of each link in the chain, from sample collection to storage, and submit recommendations for improvement that speak to all actors across in the process. Notable topics covered include:

• overuse of laboratory tests as a determent to patient safety,
• current venous blood sampling guidelines as a baseline for best practice,
• reduction of sample value due to delays and poor transport processes,
• storage of samples to retain their usefulness as sources of information, and
• the potential impact of drug test interactions on the viability of diagnosis.

The issue highlights the need for the laboratory medicine community to mitigate the potential for missteps in the preanalytical phase and minimize downstream “holes in the swiss cheese” that degrade diagnosis.

Free access to each full issue of Diagnosis, the official peer-reviewed journal of the Society to Improve Diagnosis in Medicine, is a benefit of membership in the Society to Improve Diagnosis in Medicine.