An analysis of preanalytical errors in the Biochemistry Unit of the National Referral Hospital in Bhutan: A descriptive study

Abstract

Introduction: Accurate and timely reporting of laboratory results is essential for optimal patient management. The testing process in clinical biochemistry is divided into pre-analytical, analytical, and post-analytical phases. This study assessed the sample rejection rate and identified common pre-analytical errors in the Biochemistry Unit of Jigme Dorji Wangchuck National Referral Hospital. Methods: A retrospective observational study was conducted by reviewing records of all rejected samples in the Biochemistry Unit from January 2019 to December 2020. Results: Of 197,735 samples received for biochemical testing, 283 were rejected, giving an overall sample rejection rate of 0.14%. The most common reasons for rejection were insufficient sample volume (51%) and hemolysed samples (28%). The neonatal intensive care unit contributed the highest proportion of rejected samples (32%), followed by inpatient wards (25%) and the emergency department (17%). Conclusion: The sample rejection rate in the Biochemistry Unit was low at 0.14%, with insufficient sample volume being the leading cause of rejection. Targeted training in neonatal blood collection, adherence to standardized collection protocols, and the use of micro-collection tubes may help mitigate pre-analytical errors and improve sample adequacy.