CHEMISTRY SPECIMEN ACCEPTABILITY - A COLLEGE-OF-AMERICAN-PATHOLOGISTSQ-PROBES STUDY OF 453 LABORATORIES

Objective.-To determine the frequency and reasons for rejection of che mistry specimens. Design and Setting.-College of American Pathologists Q-Probes laboratory quality improvement study prospectively recording rejected chemistry specimens in 453 laboratories. Main Outcome Measur e.-Percentage of submitted specimens rejected for testing. Results- Of 10 709 701 chemistry specimens submitted to the participating laborat ories during the data collection period, 37 208 (0.35 %) were rejected prior to testing. The institutional 1Oth, 50th (median), and 90th per centiles were 1.35%, 0.31%, and 0.06%, respectively. The most frequent reason for rejection was hemolysis, which occurred five times more fr equently than the second most cited reason, insufficient specimen quan tity to perform the test. When examined with their respective frequenc y of use, a higher percentage of rejected specimens were collected in microcollection tubes than in other containers. When compared with the respective frequency with which they collect specimens, laboratory pe rsonnel submitted significantly fewer rejected specimens than other in -hospital personnel groups and slightly more than out-of-hospital nonl aboratory personnel. The poorest performance was demonstrated by other in-hospital nonlaboratory personnel. Serum and plasma oxalate/fluorid e specimens exhibited significantly lower rejection rates when compare d with the other specimen types. Relative rejection rates were higher for nongel tubes and lower for syringes when compared with gel tubes. Conclusion.-Specimen rejection should be monitored on a regular basis. institution-specific factors that are associated with rejection shoul d be identified and targeted for improvement efforts. Action threshold s should be set sufficiently low to assure that continuous improvement is effected.