Identification errors in pathology and laboratory medicine

Medical errors are a leading cause of morbidity and mortality in healthcare. Pediatric patients receiving care in the acute or emergency setting may be especially susceptible to medical error and subsequent harm. Here we review the most common types of medical errors in pediatric emergency medicine – those related to medication, laboratory evaluation, communication, and diagnosis. Diagnostic errors are perhaps the most common but least studied type of error, though there has been recent interest in further quantifying, characterizing and preventing such error. Active research focuses on the systems issues and cognitive biases that likely play a role in this process.

Errors with laboratory specimens may lead to adverse outcomes for patients. These errors most commonly occur in the pre-analytical phase. Among these, problems with patient identification or specimen handling are most frequent. Laboratories must establish strict guidelines for appropriate specimen transport, processing, and in-lab storage for each analyte, based upon their stability at various times and temperatures. Serum and plasma specimens must be centrifuged at appropriate speeds, times, and temperatures to ensure integrity. To maintain stability, serum and plasma should be separated with an in-tube separator device, like a gel separator, or by manually aliquoting after centrifugation. Recentrifugation of gel tubes is not recommended by manufacturers, but recent studies show little to no impact of recentrifugation. Cross-contamination of specimens prior to analysis should be prevented. Laboratories should adopt strict guidelines for identifying and preventing misidentification of specimens. Patient misidentification is the most common cause of laboratory related adverse events, particularly in the blood bank. Utilization of new technology has significantly reduced these errors.

Surgical specimen management is an important responsibility of perioperative nurses and is essential to the provision of safe, quality patient care. Errors related to surgical specimen management can lead to a variety of negative consequences for patients and personnel. Unfortunately, surgical specimen management errors can and do occur, particularly during the preanalytic phase, and thus are a major perioperative patient safety concern. The overall management process for various surgical specimens is essentially the same, requiring a multifaceted, multidisciplinary, standardized method that includes specimen identification, labeling, collection, handling, transferring, containing, and transporting. For perioperative nurses to advocate for their patients and help ensure effective surgical specimen management, effective communication among care team members is imperative, along with a culture of safety that focuses on the minimization of distractions and an increased awareness of opportunities for errors.