PATH5191 L1: Preanalytical Processes 4/20/26

List the steps of the Specimen Journey after contact with the patient

1) Pathology Request

2) Collection

3) Receival/Processing

4) Testing

5) Interpretation/Pathologist Review

6) Result Reporting

7) Patient

During which 3 steps of the Specimen Journey can Order Entry/Registration occur?

1) Pathology Request

2) Specimen Collection

3) Specimen Receival and Processing

List the steps of the Preanalytical Process

1) Pathology Request

2) Collection

3) Order entry into LIS

4) Transport

5) Receival and Processing

-Testing does not count-

6) Retrieval and Transport

Which steps of the Specimen Journey are NOT Preanalytical?

Testing is not preanalytical

What is this?

-Preferred method of ordering inpatient pathology requests

-Rules out interpretation error (illegibility)

CPOE (Computerized Physician Order Entry)

What is this?

-Rule 3 Exemption

-Patient can present for tests 6x within a month or for 6 months

-Don't need new request form

-Useful for Cycled Orders

What are the Minimum Requirements of a Request Form?

1) 2 unique identifiers

-Patient Name and DOB, or Patient Name and UMRN

2) GP signature

3) Tests

True or False: Request Forms require a patient address

False, but Medicare forms do

What are the Minimum Requirements for GAS or Pre-Transfusion?

-Signed collector declaration

-Date and time of collection

What are the Minimum Requirements for a Medicare Request Form?

-Patient name and address

-Hospital status

-Doctor name, provider # and address

-Description of services, date of requests

What are the requirements for a Medicare Bill?

1) Patient Signature

2) Medicare Number

True or False: You need to obtain consent during inpatient Pre-Collection Criteria

False, consent is implied (except for children)

What should you verify during Pre-Collection Criteria?

-Meet minimum requirements

-Review pre-test criteria (fasting, time of dose)

-Positively identify patient using ID

True or False: You can assume that you have the right patient as long as you scan the wristband for a barcode

False, you cannot assume wristband is correct as the barcode may be different from medical records

True or False: Sample labelling only happens post-collection

True, you should never pre-label collection tubes

What is the first 4 items in the Order of Draw?

1) Blood Cultures

2) Blue (Sodium citrate): Coagulation testing

3) Black (ESR - Sodium Citrate): Erythrocyte sedimentation rate

4) Yellow ACD (Acid Citrate Dextrose): HLA studies

Why does the Order of Draw exist?

-Prevent cross contamination from sample tube additives

-Sometimes must invert tubes to mix additives

What information should a Test Directory include?

-Tests with aliases and alternative names

-Specimen handling, transportation, temperature

-Sample type

-Minimum volume

-Collection instructions

What does IMS stand for?

Information Management Systems

What does LIS stand for?

Laboratory Information System

What is the integration of IMS and LIS?

HIMS (Hospital Information Management System)

What PathWest Soft LIS would you use for the following?

1) Select existing order, create new order

2) Scan patient UMRN bar code

3) Select existing stay/create new stay/order (CSRA, receival area)

1) SoftWebPlus

2) SoftID

3) SoftLab

What does CSRA stand for?

-Central Specimen Receival Area

-Can receive from hospital sample chute or internal/external courier

What does the Central Specimen Receival Area (CSRA) do?

-Date, time stamp at receival

-Prioritizes: ED Samples and Urgent Samples

-Order entry/registration and scan request forms

-May centrifuge, aliquot or freeze

True or False: You are less likely to have clotting errors if you centrifuge after transport

True

What are Urgent and Prioritized Specimens by CSRA?

1) PCH pediatric samples from kids

2) Blood Gas Analysis samples

3) CSF

4) Fresh tissue (no formalin, unpreserved)

5) High-dependency wards (Emergency, ICU, DOSA/Theater)

6) GAS, IC risk

List some High-dependency wards that would be prioritized at the CSRA

1) Emergency

2) ICU

3) DOSA/Theater

How does CSRA process samples?

1) Centrifugation

2) Splitting and aliquoting (testing in multiple departments)

3) Batch transport (monitor pending lists)

4) Send-aways (for storage/transport)

5) Clinical trials

What is this?

-NPAAC

-All samples being transported must comply with their standards

-National Pathology Accreditation Advisory Council

Describe the Triple Packaging used for samples

1) Primary receptacle

2) Absorbent material

3) Secondary receptacle with leakproof outer packaging

How should samples be transported?

-Triple packaging

-Esky or hard outer package

-Biohazard label

-PathWest color coded transport label

-Urgent sticker

-Ambient temperature (cold, frozen w/ dry ice or Johnny ice brick on airplanes, Thermos)

-Formalin (tissue preservative)

What is this?

-KIMMs

-If something goes wrong, this is the RCPA QAP that you must report to

-Compare error rates with other labs

-Key Incident Monitoring and Management System

True or False: Most errors occur in Emergency and are caused by clinicians

True, clinicians have multiple jobs to do but phlebotomists have one job

What does LIS use to record these types of errors?

-Missing/incorrect tests

-Missing doctor report

-Incorrect requesting doctor

-PRBN Panel Code

-Problematic, but tests do NOT need to be cancelled

What are some reasons a test might be cancelled?

-No specimen received

-Mistakenly registered test

-Unsuitable specimen (insufficient sample/volume)

What is this?

-CARs

-Fix process/procedural issues

-Mostly for consistent or significant issues

-Corrective Action Requests

What is this?

-Clinical Incidents

-Error causes harm to patient

-Possibly disability or death

-If error is significant enough and causes harm to patient, must be investigated

True or False: Wrong Blood in Tube (WBIT) Error always happens due to deviation in procedure

True

What are some reasons that WBIT happens?

-Scanning medical records instead of wristband

-Pre-labelling tubes

-Registering new order under previous patient record

-Mislabelling tubes