283例不合格检验标本原因分析及改进措施

Analyses of reasons and improvement measures of 283 unqualified specimens for detection

目的分析临床检验不合格标本的原因,以提供真实可靠的检验结果。方法筛选2018年蚌埠市第一人民医院检验科获取的所有不合格标本,标本来源包括血液、脑脊液、胸腹水、粪、尿液、痰液等。根据《全国临床检验操作规程》及相关质量检测标准,分析不合格原因,并提出改进措施。结果2018年度本院检验科共接收不合格标本283份,分别为:标本类型错误40份(14.13%)、标本容器错误18份(6.36%)、标本量不足41份(14.49%)、标本凝集80份(28.27%)、条码问题85份(30.04%)、标本污染7份(2.47%)、采集部位错误9份(3.18%)、标本溶血3份(1.06%),其中标本凝集和条码问题与其他情况相比差异有统计学意义(均P<0.05)。不同科室不合格标本分布情况为:内科112份(39.57%)、儿科65份(22.97%)、外科45份(15.90%)、妇产科26份(9.19%)、重症加强治疗病房(ICU)18份(6.36%)、急诊科17份(6.01%),其中内科和儿科不合格标本比例明显高于其他科室(均P<0.05)。全年1月份不合格标本数分布最多(占21.55%),明显高于其他月份,差异有统计学意义(P<0.05)。结论临床检验不合格标本原因多样,严格遵守采集标准可以提高检验准确性。

Objective The causes of unqualified specimens in clinical examinations were analyzed in order to provide real and reliable test results. Methods All unqualified specimens from the First People’s Hospital of Bengbu in 2018 were screened. The sample sources included blood, cerebrospinal fluid, pleural effusion,ascites, feces, urine, sputum, etc. According to the National Practice Rules for Clinical Laboratory Examinations and the related tests quality standards, the reasons for non-conformity were analyzed, and the improvement measures were put forward. Results A total of 283 unqualified specimens were received by this Hospital Laboratory Department in 2018: 40 specimens because of type errors(14.13%), 18 specimens due to container errors(6.36%),41 specimens because of insufficient amount(14.49%), 80 specimens(28.27%) with agglutination, 85 specimens(30.04%) due to bar code problems, 7 specimens(2.47%) with contamination, 9 specimens(3.18%) because of collection site errors, 3 specimens(1.06%) with hemolysis, of which either the specimens with agglutination or specimens with bar code problems compared with any one of the other specimen situations, there were statistical significant differences(all P < 0.05). The numbers and percentages of unqualified specimens distributed in different departments were as follows: 39.57%(112 specimens) in Internal Medicine Department, 22.97%(65 specimens) in Pediatrics Department, Surgical Department 15.90%(45 specimens), Gynecology and Obstetrics Department 9.19%(26 specimens), Intensive Care Unit(ICU) 6.36%(18 specimens), Emergency Department 6.01%(17 specimens), of which the percentages of unqualified specimens in Internal Medicine and Pediatrics Departments were significantly higher than those in other departments(all P < 0.05). The percentage of unqualified specimens in January was the highest in one year, accounting for 21.55% compared with each of the other months in one year, the differences being statistically significant(all P < 0.05). Conclusion There are multiple reasons for unqualified specimens in clinical laboratory tests, so it is necessary to strictly follow the standards of collecting specimens in order to elevate the accuracy of detections.