What does it cost your organisation when a specimen is collected, but nobody knows from who or when it was taken and, in some cases, nobody can later locate it? Laboratory tests play a major role in effective diagnosis, treatment, and management of medical conditions.
In a study by Cornes et al in 2016, it was found that in the total testing process (TTP) between 46 and 68 per cent of errors were made during the pre-analytical phase. The pre-analytical phase begins when a test is requested through the specimen collection process, through transportation and up to specimen analysis.
This means that of the mistakes made in the specimen collection process, more than half occur before a specimen has reached the lab. In the health sector, errors, however minor, risk severe consequences such as misdiagnosis, delayed treatments, and even substantial financial losses for patients and healthcare facilities.
By being proactive and implementing a preventive method during the crucial pre-analytical phase, those risks can be greatly minimised.
This article aims to provide an overview of the best practices for specimen collection process, transportation, storage and disposal.
Stage 1: Specimen collection
Once a test request is received, the healthcare practitioner, normally a nurse in the hospital setting, is tasked with collecting the specimen.
Pre-collection
The pre-collection stage is the most critical phase in the TTP because it is where a significant portion of avoidable errors occur, despite not being the most technical part.
The pre-collection stage involves the following crucial steps:
Patient identification and instruction. Identify the patient’s identity with at least TWO unique identifiers before taking a specimen collection.
Using a combination of information such as their name, date of birth, or medical record number, will ensure you’re taking a specimen from the correct individual.
Once verified, ensure the patient understands the procedure they’re undergoing. Explain the type of specimens you’re collecting, including any potential risks.
Next, ensure you have the correct supplies and equipment. A healthcare professional should ensure availability of supplies and equipment (such as collection tubes, needles, sterile gloves) for the specific test. Using the wrong tube can lead to specimen degradation or interference with test results.
Proper labelling of collection containers with patient identifiers, test information, and collection time/date is vital to maintain positive patient ID (PPiD) and traceability of the specimen. Most importantly, properly labelled specimens allow labs to match orders and avoid mix-ups.
A typical large UK hospital handles more than 40,000 specimens per year.
With a large number of specimens handled in a hospital on a daily basis, errors are bound to happen. For that reason, it’s important that you take every precaution to minimise them.
A study found that hospitals could greatly reduce error incidents by using barcode wristbands and bedside labelling during specimen collection.
In the study, the hospital implementing this for the specimen collection process recorded a decrease in specimen labelling errors by 62 per cent. (Bates & Singh, 2018).
Sample360 has published a successful case study of our unique digital collection system for human samples combining mandatory PPiD using barcodes and RFID technology, where we successfully reduced specimen rejection rates to zero while maintaining 100 per cent traceability.
Collection
Each specimen uses a unique method of collection to ensure accuracy and integrity during testing.
Depending on the specimen type, the collection method and container varies, blood specimens are extracted through a process called venipuncture and stored in vials.
Urine specimens are obtained by collecting a fresh, midstream sample from the patient’s urine stream and stored in sterile containers.
Some tissue specimens during the specimen collection process may require minor surgical procedures, such as biopsies or excisions, that can only be performed by trained healthcare professionals.
In the collection stage, certain errors can occur including poor collection technique, using incorrect vials or containers for specimen collection, mislabelling or lack of proper labelling, cross-contamination of specimens, and even incorrect collection order.
Certain specimens are susceptible to degradation and contamination. Typically, blood samples are collected first and other body fluids such as stools are collected toward the end. Errors in collection order can compromise the integrity of the specimen collected, leading to inaccurate test results.
Post-collection handling
After specimen collection, certain specimens require specific processes such as centrifugation while others require immediate transportation to the laboratory.
Specimens like plain red-top tubes for basic metabolic panels or liver function tests are centrifuged to separate the cells from the serum or plasma before analysis.
Specimens in EDTA tubes for complete blood counts (CBCs) or blood cultures should be transported to the lab immediately to maintain cellular integrity and microbial viability.
A detailed requisition documentation must be included with all specimens.
Documentation helps establish the chain of custody, ensuring the correct tests are performed on each specimen, providing clinicians with results they can accurately interpret for patient care.
Post-collection errors include improper handling or processing, poor temperature control and storage conditions causing degradation, incomplete or inaccurate requisition forms, and delayed transportation or extended exposure to unsuitable conditions.
Even after a quality specimen is collected, lapses in standardised post-collection procedures create the risk of pre-analytical errors that undermine the reliability of test results.
Healthcare practitioners must follow strict specimen collection protocols for handling, processing, and documenting specimens to deliver accurate and reliable laboratory data.
Stage 2: Packaging and Transportation
Packaging
Specimens need appropriate storage on top of their primary containers to prevent degradation. During transport, they’re typically kept in temperature controlled and labelled, leak-proof containers or bio-hazard bags.
As specimens are often transported in batches to save time and costs, keeping them securely separate reduces the risk of potential contamination.
Specimens being transported will be packaged according to specific requirements.
Some may need to be frozen, refrigerated, or at ambient temperature conditions, some specimens such as blood might even require additives to maintain integrity for transport.
For example:
Blood specimens are typically placed in collection tubes containing anticoagulants or other additives necessary for the requested laboratory tests.
Urine specimens often kept in leak-proof containers will sometimes require preservatives or transport media added to prevent specimen degradation.
Stool or faecal specimens may require anaerobic transport systems or preservative media for microbiology testing.
Respiratory specimens may require addition of liquefying agents to liquefy thick specimens for easier handling and processing.
Every primary container must have a label clearly displaying patient identifiers (name, date of birth, medical record number), specimen type, and collection date/time.
Labelling is a basic but crucial step that often gets overlooked, causing mix-ups and misidentification of specimens during transportation.
Errors found at this stage of the specimen collection process include the use of incorrect packaging materials, failing to maintain proper temperature, mixing incompatible specimens together, and failing to include necessary preservatives/transport media.
These errors can degrade the specimen quality or integrity long before they reach the lab for analysis.
A key step in the Sample360 packing process is tracking and care of specimens.
A specially designed environmental monitor is placed into the cool box that constantly monitors the temperature, humidity, and G-force ensuring the specimens will endure during transit to the laboratory.
Transportation
Once packed, the transportation process should be systemised and well-organised.
Predetermined transportation routes and schedules to ensure all specimens arrive at the lab for testing in a timely manner.
Transportation logistics should account for:
Shortest routes between facilities to minimise transit time
Appropriate vehicle types (refrigerated vans/couriers)
Trained handlers following safe specimen handling protocols
Secure chain-of-custody documentation at every handoff
Relevant regulations and guidelines are in place for the transportation of biological materials that ensures the safety of both the specimens and the handlers involved.
In the transportation process, specimens can get mixed up or contaminated due to improper packaging or incorrect labelling. Other potential issues are exposure to extreme temperatures or degradation due to prolonged transit times.
Each of these issues can compromise the integrity of the specimens and lead to inaccurate test results, which could potentially cause misdiagnosis and improper treatment for patients.
Stage 3: Tracking
Specimen Tracking System
It’s not uncommon for specimens to go missing after the specimen collection process on the way to testing.
This happens either from improper handling, labelling errors, or documentation lapses during transportation.
A specimen collection tracking system is crucial for maintaining the integrity of the specimens and ensuring they actually arrive at their destination within the required timeframe.
Tracking the status of each specimen throughout the entire process ensures that any delays or issues can be identified and addressed promptly.
Unfortunately, tracking systems are not foolproof and can be vulnerable to several problems, especially human error.
These include failure to assign or record unique identifiers during the specimen collection process, inaccurate or incomplete tracking data, system errors or malfunctions in tracking software or hardware, human errors in data entry or scanning, and lack of integration between different tracking systems or processes.
Sample360 uses a tracking system combining two different technologies to location track the specimens.
The first is Bluetooth Beacons that provides localised location information.
The second is GPS that tracks the Beacons within vehicles utilising the Sample360 GPS Tracking System.
Section 4: Arrival and Storage
Arrival
Once the package arrives at its destination, the specimens should be thoroughly inspected for any signs of damage, leakage, or improper labelling.
The package and specimens should have information matching the accompanying requisition forms and any discrepancies addressed immediately to prevent errors in testing.
Requisition forms allow for proper documentation and communication between healthcare professionals and the laboratory, ensuring the patient receives the appropriate care based on accurate test results.
Requisition forms create a history of each specimen from the specimen collection process if troubleshooting is required later on.
Storage
Storage at appropriate temperatures is crucial for preserving the integrity and stability of specimens as they await analysis.
Problems that arise during arrival and storage can stem from failure to thoroughly inspect specimens upon receipt, poor storage conditions leading with temperature fluctuations, and cross-contamination or specimen mix-ups during processing.
To combat this, regular monitoring and recording of storage conditions should happen to identify any temperature deviations before specimen degradation occurs.
Backup generators attached to the laboratory can be helpful to ensure continuous temperature control in the event of power failures.
Section 5: Disposal
Finally, disposal.
Once tests have been completed, the specimens are scheduled for disposal according to protocol.
Due to their bio-hazardous nature containing potential pathogens, they cannot be disposed of through traditional means such as regular rubbish or sink drains.
The materials must first be classified according to their potential hazard level before disposal, such as biohazardous, chemical, or radioactive waste.
Bio-hazardous waste like blood specimens and microbiological cultures typically require decontamination through autoclaving or incineration.
Waste streams should be carefully segregated by hazard category to prevent cross-contamination. This involves using separate, leak-proof containers with biohazard labels for each waste type, for example sharps, soft bio-hazardous waste, chemical waste, radioactive waste etc.
Choosing not to strictly follow local or government regulations for proper biomedical and hazardous waste containment, handling and disposal can have severe environmental and public health impacts on the surrounding community. Fines and penalties for violations can also be substantial.
Proper handling of human samples through the specimen collection process is critical for ensuring accurate and reliable laboratory testing.
An error in any stage of this process can have potentially disastrous consequences such as misdiagnosis and delayed or improper treatment causing death and disability. This can in turn result in substantial costs borne by both patients and healthcare facilities.
However, even when adhering to best practices for specimen collection, labelling, packaging, transportation, storage, and disposal, there is still a risk of potential error.
The benefits of digitalised specimen handling cannot be overstated.
It minimises the risk of pre-analytical human errors that can compromise specimen quality and test result integrity.
Sample360’s digital solution combining RFID technology and specialised tracking system offers a comprehensive safeguard designed to eradicate challenges faced by clinics, GP surgeries, and hospitals during specimen collection and testing.
With its proven system of reducing sample rejection rate to zero, Sample360 addresses the gaps and potential pitfalls in specimen handling and transportation.
Specialised environmental monitoring, meticulous tracking, and adherence to predetermined transportation routes and schedules are just some of the measures implemented to ensure your specimen collection process is reliable from collection to testing.
Don’t leave the integrity of your specimens to chance.
Contact us today to schedule a demo and learn how Sample360 can revolutionise your organisation’s approach to human sample handling.
References
Cornes MP, Atherton J, Pourmahram G, et al. Monitoring and reporting of preanalytical errors in laboratory medicine: the UK situation. Annals of Clinical Biochemistry. 2016;53(2):279-284. doi:10.1177/0004563215599561
Bates DW, Singh H. Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety. Health Aff (Millwood). 2018 Nov;37(11):1736-1743. doi: 10.1377/hlthaff.2018.0738. PMID: 30395508.
van Moll C, Egberts T, Wagner C, Zwaan L, Ten Berg M. The Nature, Causes, and Clinical Impact of Errors in the Clinical Laboratory Testing Process Leading to Diagnostic Error: A Voluntary Incident Report Analysis. J Patient Saf. 2023 Dec 1;19(8):573-579. doi: 10.1097/PTS.0000000000001166. Epub 2023 Sep 28. PMID: 37796227; PMCID: PMC10662575.
