Posted by Sten Westgard, MS
Recently, the Journal of Veterinary Diagnostic Investigation had an interesting paper on error rates:
An error management system in a veterinary clinical laboratory, Emma Hooijberg, Ernst Leidinger, Kathleen P Freeman, J Vet Diag Invest 2012 24(3): 458-468.
If we look at error rates in a vet lab, do you think they're better or worse than the "normal" clinical laboratory? The results may surprise you...
Hooijberg et al took at look at all phases of the Total Testing Processes, Pre-analytical, analytical and Post-analytical. They looked at lab rates from 2003 through 2010, so a nice long-term study, where each year examined between 30,000 and 52,000 samples.
While we can't show them all, we'll highlight some of the interesting metrics:
| Total breakdown of errors from 2003 through 2010 (332,882 total samples): | ||
| Process | # Errors | Sigma-metric |
| Pre-analytical errors | 2,032 | 4.1 |
| Data entry errors (pre) | 845 | 4.4 |
| Analysis errors (includes QC) | 176 | 4.8 |
| Invoicing errors | 38 | 5.2 |
| 2010 error rates for Hemolysis and Lipemia (51,743 samples) | ||
| Hemolysis | 1,993 | 3.3 |
| Lipemia | 1,712 | 3.4 |
A few comments here. The study excluded hemolysis and lipemia from their TTP calculations, so that their 4.1 Sigma for Pre-analytical errors doesn't include those errors. Instead, the study treated those errors in a separate table. Clearly, though, hemolysis and lipemia is the major problem they face. Put those two error rates together and they eclipse all the other errors in the TTP combined. This is a problem that vet labs have in common with many clinical laboratories.
Compare these rates to other reports of error rates in laboratories and you'll see that while some error rates in a vet lab are higher than in clinical laboratories that service people instead of pets, the rates aren't that different. Some of the significant differences can be explained by the fact that vet labs aren't as thoroughly automated yet. They still have to manually input some of their ordering and results, which, we know, is a more error prone process.
Second comment: one of their absolutely best processes was getting the bill right! Clearly, the financial incentive shapes the priorities for improvement and quality.
Again, here's the link to the study (free):
An error management system in a veterinary clinical laboratory, Emma Hooijberg, Ernst Leidinger, Kathleen P Freeman, J Vet Diag Invest 2012 24(3): 458-468.
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