An investigation of rejection rates, sources thereof and methods to reduce specimen rejection

Abstract

Background Specimen rejection occurs when specimens are sent to a medical diagnostic laboratory and are deemed unsuitable for analysis based on specimen acceptability criteria. Patient care may be hindered due to rejections. Specimen rejections impact negatively on patients, healthcare workers and the diagnostic laboratory. The aim of this study was to investigate specimen rejection rates, the contributing factors, and methods to reduce the number of rejected specimens, thereby improving healthcare for the patient as well as improving the financial and quality standing of the laboratory. Materials and methods Rejection statistics were obtained for King Dinuzulu Hospital Complex (KDL) and RK Khan Hospital (RKK) for a period of six months. An investigation of the rejection rates and common causes for rejection was conducted. The information gathered from the rejection statistics was used to create training material for training workshops. Pre training and post-training questionnaires were completed to determine the effectiveness of the training. Rejection statistics were re-collected for two months post the training workshop sessions to evaluate the rejection rates for improvement. Results The initial rejection rates indicated that KDL and RKK exceeded the allowable limit of rejections (National Health Laboratory Service allowable limit < 3%). The primary reason for specimen rejections was identified as errors that occur in the pre-analytical phase, with haemolysis emerging as the predominant contributing factor. Training workshops were conducted, although the improvement in assessment score for the workshop was 49.6% (p < 0.001), the rejection statistics collected post-training workshop showed an insignificant change in overall rejection rates at KDL and RKK (p-value = 0.139 and 0.242 respectively). Conclusion Specimen rejection is a growing problem that requires mitigation. Structured training has shown to improve pre-analytical knowledge, however, it was noted that the interventions taken by offering training workshops did not reduce the rate of specimen rejections.