对CAP Q—TRACK不合格标本质量指标监测的分析

Analysis of quality indicator of disqualified sample by participating CAP Q-TRACK

目的通过分析不合格标本拒收的原因，找出减少不合格标本产生的对策，提高实验室分析前质量，确保检验质量的持续改进。方法回顾性分析首都医科大学附属北京朝阳医院检验科2013年10月至2014年9月参加美国病理家学会（CAP）质量管理工具．质量追踪（Q—TRACKSQT3）结果，统计分析该时间段内各类不合格标本数量及所占比例，并将我科拒收比例与CAP所有参加实验室拒收比例进行比较。结果2013年10月至2014年9月，检验科血液标本共拒收2367份，不合格标本拒收的原因主要为3种，分别为标本标识不完整、标本凝血、标本量不足。2367份不合格标本中，标本标识不完整的标本有225份，所占比例为9．5％；抗凝标本出现凝块的标本有898份，所占比例为37．9％；采样量不足的标本有254份，所占比例为10．7％。拒收比例占1％以上的其他原因有标本容器错误、标本溶血、标本脂血、黄疸。我科拒收率与CAP所有参加实验室拒收率比较，发现前5位拒收原因并不相同。结论标本质量对于检验结果准确、可靠至关重要，通过积极统计分析不合格标本的产生原因，并采取相应措施，可有效降低不合格标本的比例。

Objective Through statistical analysis of specimen rejection reasons, aimed at finding the ways to reduce the failed specimen, making sure of continuous improvements in laboratory quality. Methods Department of Laboratory, Beijing ChaoYang Hospital, Capital Medical University had analyzed rejections specimen from October 2013 to September 2014 in CAP Q-TRACKS QT3 （ QT3： Laboratory＂ Specimen Acceptability）, and compared the laboratory rejection reasons with all laboratories of CAP. Results From October 2013 to September 2014, the total number of rejection specimen number was 2 367, in which 225 were incomplete labeled specimen/inadequate filled-out form, accounting for 9. 5% . 898 samples were rejected because of specimen clotted, accounting for 37. 9%. The samples could not meet the requirement of specimen quantity of 254, accounting for 10. 7%. Other reasons accounting for above 1% included wrong collection container, specimen hemolysis, lipemia or icteric specimen. After comparing the first five rejection reasons, Department of Laboratory, Beijing ChaoYang Hospital was found to be different with others laboratories of CAP. Conclusion The quality of the specimen is very important for the accuracy and reliability of the test results, and doing some positive statistical analysis and taking corrective measures can effectively reduce the unqualified specimen of the proportion.