Clinical samples are important. Samples collected at a doctor’s office or hospital are used to diagnose disease, guide treatment, and predict patient outcomes. They’re also important for drug discovery and development, where they can be used to track disease stages, look for biomarkers, develop diagnostic assays, and many other purposes. Knowing how to deal with the many different types of samples coming into lab facility on a daily basis, however, isn’t easy. Good sample management practices rely on good communication.
Clinical samples include many different types of specimens, often requiring a diverse array of storage containers, labelling procedures, and storage temperatures. And because clinical personnel are not always specifically trained in specimen collection and storage procedures, a lot of confusion can result when samples are collected into the wrong size or type of container or given the wrong type of label. Errors lead to lost work time, especially if there is inadequate sample tracking information.
Specimen tracking is a crucial part of the management process. Once a specimen gets collected, keeping track of both the sample and all of the data associated with it can be challenging. Which patient did the sample come from? How was it collected? Were all of the correct protocols followed? What tests have been carried out, and what were the results? Are there other samples from the same patient? The list goes on and on, and it takes a sophisticated system to both record all of the necessary information and ensure that it’s easily accessed when needed.
There’s a lot of advice out there on tools and management systems that can be used1,2 to improve clinical sample management, but a recent study at the Dartmouth-Hitchcock Medical Center in New Hampshire3 focused on a simple truth—that good communication is perhaps the most important ingredient.
The impetus for the New Hampshire study came when operating room (OR) specimens arrived at the lab facility in the wrong container, and with incorrect order information. Since this wasn’t the first time handling procedures had been carried out incorrectly, lab managers decided to meet with OR nurse educators to discuss the handling process. This revealed that the OR personnel had been relying on a “cheat sheet” to tell them how to collect and label samples. Unfortunately, the sheet contained incorrect or outdated information for several sample types. Rather than simply updating the sheet, the hospital decided to dig deeper. Clearly, something about the whole specimen management process wasn’t working, because the meeting between lab and OR personnel made it obvious that there was a lot of stress and confusion on both sides. Dartmouth-Hitchcock Medical Center enlisted the help of the Value Institute Learning Center, a hospital program developed specifically to address process improvement.
The review process uncovered several basic problems. Turnover for OR scrub technicians and nurses was fairly high, and staff were often not formally educated in specimen ordering terminology and procedures. There was very little easy access to information on proper collection, labelling, or sample ordering techniques. There was miscommunication regarding the necessity for different container types for specific specimens, and labels would often not print until certain outside criteria, for example, patient rooming status, was registered. Communication barriers such as multiple listed numbers and telephone transfers, led to confusion, delays, and the need to re-do work in the lab facility. Ordering systems differed between the lab facility and the OR.
Together, the hospital staff worked to come up with solutions to each of these problems. Education session were developed and held for all incoming OR staff. The specimen container drawer in the OR was re-organized with clearly marked container areas, and laminated container reference cards were issued for the OR staff. Laminated cards at all label printing areas showing step-by-step procedures for printing required labels and replacing label rolls. Hospital staff were made aware of where to find specimen tracking and management software suppliers, including our own FreezerPro® lab management software, in case they had any questions on how to organize and locate OR specimens.
Since instituting the process changes, Dartmouth has seen a 40% drop in specimen management errors. Moving forward, the hospital wants to ensure greater control over the specimen collection and management process by keeping the lines of communication open between the lab and the OR. They’re now tracking the number and types of processing errors, and regularly meeting with staff members to reinforce the new sample management procedures. As Dartmouth-Hitchcock states, “the real success of these projects is measured in sustainability”. In other words, good communication often leads to the best solutions.
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1. Sweeney S. Strategies for Improving the Onsite Management of Scientific Sample Assets. Pharmaceutical Outsourcing. Sept 2011.
2. May M. Improving Clinical Specimen Management. Lab Manager. Sept 2016.
3. LeBlanc L. Improve Microbiology Specimen collection in the OR. Medical Lab Management, 16-22. April 2018.