PRE-ANALYTICS
consequences that is incorrectly blamed on the laboratory. In some hospitals, phlebotomists print the blood tube labels at a central nursing desk and then try to match with the patients on their ward round. Not surprisingly, they often get it wrong (~1% of the time), assigning someone else’s results to a patient. Considering the impact of an error rate of just 0.6%, observed in one hospital studied, for a teaching hospital with 1,000 beds that bleeds 300 patients every day, this means at least two incorrect results every day or ~800 incorrect results per year. If only 5% of these tests are critical then it is possible to estimate that each year around 40 patients are harmed. Wrong-blood-in- tube (WBIT) incidents remain among the most serious of threats.
Paper trail Over the past decade, a growing number of trusts have invested in automated laboratory track systems that process thousands of samples per hour. Their analyser error rates are as low as 0.0001%. The irony is that this extraordinary precision at the analytical stage is entirely undermined by poorly labelled or degraded tubes. Despite advances in laboratory technology over the years, many healthcare systems depend on paper forms, handwriten labels, and fragmented communication between clinical and laboratory teams. To reduce paper, Barak and Jaschek highlighted IT-drive measures, such as barcoded tubes, centralised LIS integration, and automated clinical-to-laboratory data transfer. Their approach reduced pre- analytical errors from 2.7% to 0.77% across millions of tests.1
Call to laboratories Pathology laboratories can no longer afford to be passive recipients of bloods with botched handling. The NHS Geting It Right First Time (GIRFT) programme exists precisely to eliminate the kind of harm that pre-analytical errors generate. Its pathology framework mandates that quality must be measured and improved across the entire diagnostic journey, from when a clinician orders a test to the moment a result reaches them, not just within the four walls of the laboratory. Laboratories must become internal champions within their trusts. That means showing CEOs and operational decision-makers that without modernising the pre-analytical stage, the hospital will continue to waste money and generate incorrect blood results. There is litle point in paying millions for a state-of-the-art analyser with an error rate of 0.0001%, if a poor pre-analytic workflow continues to generate errors and harm patients.
Poor quality barcode labels mean that 12-15% of all tubes labelled with a barcode have to be pulled from the analyser and manually re-labelled.
North Central London lesson Hospitals in the North Central London Integrated Care Board (NCL ICB) provide an example of transformation of blood tests into a hassle-free experience for patients and professionals. Thanks to digital integration at the point of care, digital blood forms, and enabling patients to be bled anywhere in the area; they have created an opportunity for pharmacy and community phlebotomy to work in tandem. Ultimately primary and secondary care patients in NCL will get their bloods tested closer to home and have them correctly processed for their results to be sent to the clinician. Importantly, the solution avoids
re-labelling and has full tracking: from ordering to arrival in the laboratory. An integrated solution so that patients are not turned away if they lack a paper form. It opens up community phlebotomy in ways never imagined before. For the laboratory it means achieving the GIRFT objective and making headway into the backlog of tests that continue to accumulate every day. For patients it means geting the right results first time round.
Harnessing the pre-analytical stage The scale of pre-analytical error in UK phlebotomy is not a laboratory problem, but is a process failure hiding in plain sight. From mislabelled tubes and incompatible barcodes to degraded samples and wrong patient assignments, the consequences are measurable in patient harm, not just wasted time and taxpayer resources. The solution is not more advanced analysers, but smarter integration at the point of
care. As the North Central London example demonstrates, digital end-to- end workflows can tackle the errors that take place in the pre-analytical stage and deliver on the promise of geting it right first time.
References 1 Barak M, Jaschek R. A new and effective
way for preventing pre-analytical laboratory errors. Clin Chem Lab Med. 2014;52(2):e5-e8. doi:10.1515/cclm-2013-0597
2 Carraro P, Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Clin Chem. 2007;53(7):1338-1342. doi:10.1373/clinchem.2007.088344
Professor Kevin Moore MB BS FRCP BSc PhD, is Chief Medical Officer and Co-founder at Salutare. A Professor of Medicine at UCL, an experienced clinician working in the Royal Free London as a hepatologist, acute physician and a clinical pharmacologist, Professor Kevin Moore is also an author of the Oxford Handbook of Acute Medicine with around 200,000 sold copies. As a clinician, he has experienced the many frustrations of manual workflows, which lead to patients becoming lost in the system, either in referral or long-term follow-up. During the COVID-19 pandemic the problems faced by the many patients under long-term surveillance became acutely manifest, leading him to tackle the technological challenges impacting patient safety head-on by co-founding Salutare. Salutare builds software to help improve the lives of patients and clinicians. That means simpler referrals, clearer processes, and faster time to review.
www.salutare.co.uk August 2026
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