Computerized physician order entry and query-host communication may help reduce this type of error. https://doi.org/10.1515/cclm.2011.600.Search in Google Scholar, 8. J Surg Oncol. Inappropriate label alignment means no reading by the bar-code readers located in the total laboratory automation system. Secondly, some possible improvements in these errors by non-analytical automation will be focused on. Serrano Mdel R, Mira NO, de Gopegui ER, Ovies MR, Cardona CG, Prez JL. Specimen safety is provided, and resampling is prevented. Controlling clinical laboratory errors Dr. Rajesh Bendre 4.2K views42 slides. The phlebotomist waits for complete filling. Unfortunately, there are limited numbers of studies focusing on the error improvements by implemented tools. As a result, non-analytical automation within and outside the clinical laboratory will necessarily lessen the error sources effect on the total test process, enhancing the quality of the test results. Unfortunately, we seem to be arguing that some errors are more important (i.e. Automated centrifugation prevents inappropriate centrifugation conditions, shortening TAT, and providing staff safety. Please login or register with De Gruyter to order this product. What are the three types of product modifications? Missing sample and/or test request is prevented by computerized physician order entry and query-host communication. The tube loader and sorter execute the submission function and provide efficient specimen traceability. Automation and expert systems in core clinical chemistry. Term When a phlebotomist gives aid during an emergency, he/she is usually protected through? Automation of analytical and extra-analytical phases of laboratory processes enhanced clinician and patient satisfaction, which is because prompt, electronic reporting of test results and critical value alerting by bioinformatics as well as test quality are of critical importance [28], [37]. Snyder, ML, Carter, A, Jenkins, K, Fantz, CR. Rifai, N. Tietz textbook of clinical chemistry and molecular diagnostics E-book, Kindle locations: 40565, 40595, 40607, 40623, 40630, 40667, 40684, 40688, and 40708, Kindle edition. Klinik laboratuvarda non-analitik otomasyon ile extra-analitik faz hatalarnn nlenmesi, Bakan, Ebubekir and Bakan, Nuri. Impairment in secondary sample traceability. Boyd, JC, Hawker, CD. Wayne, PA: Clinical and Laboratory Standards Institute; 2005.Search in Google Scholar, 12. What are the pre examination errors can occur with a sample and how these errors can affect a patients outcome? Turkish Journal of Biochemistry, Vol. sharing sensitive information, make sure youre on a federal Then, the improvements can be measured and evaluated by the usage of quality indicators (QI). The automation, for the past two decades, has also covered extra-analytical as well as analytical procedures. The Environmental Health Analytical Services Branch, Medical Microbiology Branch and Laboratory Preparedness and Response Branch. The current developments in non-analytical automation provide error elimination, improve the quality, and reduce the labor, costs, and TAT [3]. Auto-verification is essential for clinical laboratory automation and is based on computer sciences, with no manual intervention. adjective. The automated specimen storage and retrieval system anticipates the inappropriate storage condition of the samples in the posttest phase, meaning sample safety and improved TAT. When there were two errors 5.3% failed to report either error and 8.8% only reported one error. In clinical laboratory practice, the errors in the testing process are primarily associated with extra-analytical phase error sources, influencing the test result quality profoundly. Positive patient identification by bioinformatics prevents wrong/missing identification of the patients. The implementation of non-analytical automated systems requires a risk management strategy based on laboratorys workflow and bottlenecks. For Non-Laboratory Inquiries, please call the Department of Health Information Line : (808) 586-4400 . Preanalytical errors (PAEs) are errors which occurprior to the analytical stage in the total testing process(TTP) and can occur both before and after receipt ofspecimens in the laboratory. https://doi.org/10.1016/j.cll.2016.09.015.Search in Google Scholar National Library of Medicine Automation in the clinical laboratory: integration of several analytical and intra-laboratory pre- and post-analytical systems. The tube labeler and preparer restrains poor label alignment on the specimen container, especially in outpatients, reducing TAT. 1. Quality indicators for the total testing process. Never allow unlabelled or mislabeled samples to be relabeled, if recollection is feasible. 1992 Jul;116(7):694-700. Prevention of extra-analytical phase errors by non-analytical automation in clinical laboratory. Samples should be transported non-refrigerated at ambient temperature (15-25 C) in as short a time as possible [8 . https://doi.org/10.1515/cclm.2006.123.Search in Google Scholar, 27. Reliable reporting of laboratory results is an important component in the diagnosis and management of infectious diseases. Reducing the occurrence of errors in a laboratory's specimen receiving Such a drop is not only due to the increasing automation of laboratory processes but also has resulted from the introduction of the External Quality Assurance Program (EQAS; Bio-Rad Laboratories, Inc., Hercules, CA) to assess the . [Analysis of the results of the SEIMC External Quality Control Program. We investigated the frequency of pre- and post-analytical errors by participants in the Royal College of Pathologists of Australasia (RCPA) Microbiology Quality Assurance Program (MQAP). https://doi.org/10.1515/cclm.2009.048.Search in Google Scholar The quality of clinical laboratory measurement is comprised of 2 phases, the analytical and non-analytical phases. Sonu olarak, klinik laboratuvar iindeki ve dndaki non-analitik otomasyon, hata kaynaklarnn toplam test sreci zerindeki etkisini kanlmaz olarak azaltacak ve test sonularnn kalitesini artracaktr. 8. When a phlebotomist gives aid during an emergency? Preanalytical phase comprises of test selection, patient identification, collection of the sample, handling of the sample, sorting out, pipetting and centrifugation (2, 3). Introduction. Wallin, O, Soderberg, J, Van Guelpen, B, Stenlund, H, Grankvist, K, Brulin, C. Preanalytical venous blood sampling practices demand improvement: a survey of test-request management, test-tube labeling, and information search procedures. Graduated from ENSAT (national agronomic school of Toulouse) in plant sciences in 2018, I pursued a CIFRE doctorate under contract with SunAgri and INRAE in Avignon between 2019 and 2022. This module of the pre-analytical system checks sample integrity. Nowadays, a well established quality control system has been applied. Sciacovelli, L, Plebani, M. The IFCC Working Group on laboratory errors and patient safety. Abstract The majority of errors in laboratory medicine occur in the pre- and postanalytical phases of the testing process. In: Rifai, N, Horvath, AR, Wittwer, CT, editors, Tietz, textbook of clinical chemistry and molecular diagnostics; 2018:6 p.Search in Google Scholar, 4. Short-term interventions onwards fail to reduce pre-analytical errors: results of two prospective controlled trials. 1. Volume/clotting/bubble-controlling unit in pre-analytical automation. This study demonstrates that there are considerable high rate of post-analytical errors in laboratory reports. Analytical and post analytical errors in laboratory Hanisha Erica Villaester 36.3K views12 slides. worse) than others. In vitro hemolysis may partly be averted by adaptor usage, using automated venous sampling systems, and using devices to find the veins or real-time digital imagers for sampling. Sciacovelli, L, Plebani, M. The IFCC Working Group on laboratory errors and patient safety. Inappropriate blood to anticoagulant ratio. Wallin, O, Soderberg, J, Van Guelpen, B, Stenlund, H, Grankvist, K, Brulin, C. Preanalytical venous blood sampling practices demand improvement: a survey of test-request management, test-tube labeling, and information search procedures. Clinical and Laboratory Standards Institute. The auto-verification either sends the patients reports directly to the clinicians desktop or blocks them for the laboratorian to concentrate on the pathological results. By using bioinformatic technology and robotics, thousands of clinical laboratories worldwide could have the opportunity to reduce errors caused by pre-analytical processes, resulting in improvement in accuracy and TTP. Plebani, M, Sciacovelli, L, Aita, A, Padoan, A, Chiozza, ML. In succeeding years, the MQIs were discussed and approved in the 2013 Padova Consensus Conference and were tested on different occasions. Retrospective analysis of 36 years. The investigation of pre-analytical factors in laboratory medicine is pivotal to improve the overall clinical laboratory quality, and in turn to ensure the patient safety ().In this regard, phlebotomy is addressed as a crucial process in the pre-analytical phase, in which a large part of laboratory errors is thought to arise, having the potentialities to affect largest part of . We retrospectively reviewed MQAP data 1987-1991 and 2004-2008. Objective: To determine types and frequency of errors in diagnostic laboratories among selected hospitals in East Wollega Zone, Oromia, Ethiopia. The detection and prevention of errors in laboratory medicine The extra-laboratory errors occur in the pre-pre-analytical phase, and intra-laboratory errors in the intra-aboratory pre- and post-analytical phases. In automated centrifugation, the standardization of the requirements such as balancing is possible, which is necessary for specimen (naturally patient) safety. Soderberg, J, Brulin, C, Grankvist, K, Wallin, O. Pre-analytical errors in primary healthcare: a questionnaire study of information search procedures, test request management, and test tube labeling. Beside general causes such as identification errors and unsuitable transportation, which do . For safe transportation by PTS, a carrier with a high radius (about 160mm), soft material support within the carrier, low or optimized acceleration and deceleration, non-sharpened corners or bending points in the tubing network may be critical. The tube labeler and preparer may lessen the errors associated with inadequate label alignment on specimen containers, especially for outpatients. Effects of non-analytical factors on the quality of laboratory results Plebani, M. Errors in clinical laboratories or errors in laboratory medicine? Specimen quality is critical for producing a high-quality test result. Hawker, CD. Then, the application of QIs for different steps allows measuring the improvements in TTP. Testing duration beginning with sample load to the analyzer and ending with readout. Before reported the pre-analytical error types [41]. Fictitious errors were defined as the reporting of a labelling error when in fact there was no discrepancy. Clin Chem Lab Med 2006;44:7509. The errors of non-analytical phases of examination in medical laboratory Clin Chem Lab Med 2011;49:111326. What is the structural formula of ethyl p Nitrobenzoate? No Preanalytical Errors in Laboratory Testing: A - ResearchGate Possible chaos and sample loss for rare tests are prevented. Guest Essay Pre-, Post- & Analytical Errors Guest Essay Pre-, Post- & Analytical Errors Written by David Plaut, Sten Westgard, and James O. Westgard. Thus, the management of these critical error sources makes their effects preventable thanks to automation and computer sciences. A single operator can manage the entire system. Clipboard, Search History, and several other advanced features are temporarily unavailable. Unauthorized use of these marks is strictly prohibited. The respondent rate was 71%. Clin Chem 2010;56:151314. Automated transport and sorting system in a large reference laboratory: part 1. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.Search in Google Scholar, 23. Quality indicators in laboratory medicine: a fundamental tool for quality and patient safety. . Table 1 shows some definitions of clinical laboratory automation and the issue, which the reader can consult for clearance. Excessive massaging or squeezing of the puncture site should be avoided in order to prevent hemolysis, contamination of the blood with interstitial and intracellular fluid, and obstruction of blood flow. It is associated with automated specimen storage and retrieval, which makes it easy that the storage conditions are standardized, and that the retrieval is fastened. Automation in the clinical laboratory: integration of several analytical and intra-laboratory pre- and post-analytical systems. Tube labeler and preparer. Objective The objective of this study was to determine the magnitude of pre-analytical, analytical and post-analytical laboratory errors in hematology tests. Arch Pathol Lab Med. The frequency and potential clinical impact of non-analytical errors in Non-analytical automation within and outside the clinical laboratory will standardize as possible as the processes in that phase. During the past few decades, the number of laboratory errors in the analytical phase has decreased dramatically. 4. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. Lippi et al. The detection and prevention of errors in laboratory medicine Pneumatic-tube-systems. How many more times should a phlebotomist try to perform a venipuncture on a patient if he has failed once already? Plasma tube with physical separator. The two major causes of analytical errors are instrument malfunction and operator error. Positive patient identification provided by several technologies may prevent this type of error. Computerized physician order entry and query-host communication, Usage of an adaptor, automated venous sampling system, and real-time digital imager, Usage of an adaptor and the containers with a pre-determined vacuum volume, Inappropriate blood to anticoagulant ratio, Inappropriate transport and storage conditions, Inadequate label alignment on the specimen tubes, The low-resolution print quality of the bar-code label, Decapper, aliquoter, bar-code labeler, and recapper module in pre-analytical automation systems, Delay in sample processing steps in laboratory, Delayed submission and inefficient specimen traceability, An automatic tube loader and sorter usage, Automated systems processing primary tube. The receipt and processing of specimens is . Clin Biochem 2013;46:11704. 2001 Sep;116(3):311-5. doi: 10.1309/H0DY-6VTW-NB36-U3L6. Patient misidentifications caused by errors in standard bar code technology. Removal of this error source by automated devices improves total TAT. Plebani, M, Astion, ML, Barth, JH, Chen, W, de Oliveira Galoro, CA, Escuer, MI, et al.. Harmonization of quality indicators in laboratory medicine. What are analytical errors? - Studybuff.com https://doi.org/10.3343/alm.2012.32.1.5.Search in Google Scholar, 6. Describing any procedure that takes place before an analysis. In the laboratory, errors can occur at any stage of sample processing; pre-analytical, analytical, and post analytical stages. Similarly, there is a considerable overlap of pre-analytical error types with MQIs. Otomasyon teknolojileri, laboratuar tbbnn yeterlilii zerinde ciddi bir etki yaratmtr. What are the pre-analytical errors in laboratory? Available from: https://www.accuvein.com/products/catalog/av500-vein-viewing-system/ [Accessed Mar 2020].Search in Google Scholar, 10. Laboratory results. J Surg Oncol. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Wiwanitkit, V. Types and frequency of pre-analytical mistakes in the first Thai ISO 9002: 1994 certified clinical laboratory, 6-month monitoring. PMID: 10926259 Abstract The quality of clinical laboratory measurement is comprised of 2 phases, the analytical and non-analytical phases. Angew Chem Int Ed Engl 2010;49:102651. Non-analitik otomatik sistemlerin uygulanmas, laboratuvarn i akna ve darboazlara dayal bir risk ynetimi stratejisi gerektirir. Similarly, some of the technological and computer-aided bioinformatic solutions have been able to be implemented to the extra-laboratory part of the non-analytical phase, resulting in partial automation in that phase. Negligence in any of these steps can lead to erroneous results attributed to preanalytical phase. 6. PubMed, 40. Types of analytical errors in laboratory are often 10% but frequency has decreased in the last decade in diagnostic testing. 10 Quality improvement initiatives must . https://doi.org/10.1016/s0009-8981(98)00148-x.Search in Google Scholar, 20. However, the non-analytical phase is a state of the art that must be paid attention to. 2002;33 Suppl 2:14-7. A risk management strategy, for this reason, should first be developed for the systematic analysis of the present laboratorys workflow and bottlenecks. Decapper, aliquoter, bar-code labeler, recapper units of modular pre-analytical prevent these errors. https://doi.org/10.1080/00365519950185328.Search in Google Scholar 2. A 5 decimal or 5-digit analytical balance is a precision weighing instrument that can measure weight to an accuracy of 0.00001 grams. For instance, while a 2mL-vacuum is enough for complete blood cell counting tubes at sea level, at least a 3mL-vacuum volume is necessary for that kind of sampling at 2,000m altitude (by our experience). However, it is clear that non-analytical automation effectively reduces the number of laboratory errors occurring during TTP [31], [32]. Why are pre analytical variables important to be aware of performing clinical chemistry testing? Heterogeneous and ambiguous definition of what a laboratory error really is; 2. Analytical variables occur during actual testing of the specimen. Durner, J. Prevention of extra-analytical phase errors by non-analytical automation in clinical laboratory, Downloaded on 9.7.2023 from https://www.degruyter.com/document/doi/10.1515/tjb-2020-0483/html, Classical and Ancient Near Eastern Studies, Library and Information Science, Book Studies, https://doi.org/10.1126/science.295.5554.517, https://www.accuvein.com/products/catalog/av500-vein-viewing-system/, https://doi.org/10.1373/clinchem.2010.150094, https://doi.org/10.1373/clinchem.2010.153288, http://gelecekmuhendislik.com/futurelab-labeler/, https://aerocom.de/en/pneumatic-tube-systems-products/, https://doi.org/10.1016/s0009-8981(98)00148-x, http://gelecekmuhendislik.com/futurelab-sorter/, https://doi.org/10.1080/00365519950185328, https://doi.org/10.1016/j.jala.2008.12.001, https://doi.org/10.1016/s0009-8981(03)00020-2, https://doi.org/10.1093/clinchem/48.10.1751, https://doi.org/10.1043/1543-2165(2007)131[1063:SAFTCC]2.0.CO;2, https://doi.org/10.1093/clinchem/48.10.1761, https://doi.org/10.1016/j.cca.2009.03.024, https://doi.org/10.1016/j.cca.2008.02.016, https://doi.org/10.1043/1543-2165(2006)130[1662:PSITCL]2.0.CO;2, https://doi.org/10.1016/j.cca.2013.07.033, https://doi.org/10.1016/j.clinbiochem.2012.11.028, https://doi.org/10.1016/j.cca.2009.03.025, https://doi.org/10.1016/j.cll.2016.09.015, Medicine in philately: History of Quarantine, Serum microRNA signature is capable of predictive and prognostic factor for SARS-COV-2 virulence, The method comparison and the verification of precision of Mindray CL-6000i thyroid function tests (TFTs), Measurement of serum creatinine levels with liquid chromatography-tandem mass spectrometry: comparison with Jaffe and enzymatic methods, The importance of sPD-1, sOX40L and sGITR in terms of clinicopathology and histopathology in gastric cancer, Suberoylanilide hydroxamic acid inhibits LX2 cells proliferation via decreasing yes-associated protein/transcriptional coactivator with PDZ-binding motif proteins, Effect of protocatechuic acid against renal ischemia reperfusion damage on extracellular matrix integrity and related signal pathways, The role of zonulin in the pathogenesis of diabetic retinopathy, The general term used for automated clinical laboratory (instrumentation+LIS/HIS), Laboratory automation composed of heterogeneous, physically-integrated analytical and extra-analytical systems (many analyzers performing different types of tests on different sample matrices), Automated analytical systems or workstations, Part of laboratory automation other than analyzers; signifies pre- and post-analytical automation, Intra-laboratory non-analytical automation, Pre-analytical automation within the clinical laboratory (pre- and post-analytical automation), Extra-laboratory non-analytical automation, Pre-analytical automation outside the clinical laboratory; signifies prepre-analytical phase automation, Intra- and extra-laboratory processes other than analytic processes, An analyzer interfacing the integrated laboratory automation system, An analyzer interfacing with no integrated laboratory automation system; stand-alone analyzer, An automation composed of pre-analytical, analytical and post-analytical component linked by a conveyor, An analyzer designed as modules; module addition or exclusion possibility depending on the need, A non-analytical system designed as modules; module addition or omission possibility depending on the need, A pre-analytical specimen processor interfacing no analyzer, The duration in which the laboratory reports the test result. Inappropriate transport and storage conditions may be put an end to by PTS, which is closely associated with improved TAT and high-quality testing. Clin Chem 2010;56:155460. Part 2: implementation of the system and performance measures over three years. 235-243. Available from: http://www.technomedica.co.jp [Accessed Mar 2020].Search in Google Scholar, 15. Clin Chem 2002;48:17617. Boyd, J. Robotic laboratory automation. Medical laboratories: requirements for quality and competence. Extra-analytical and analytical components have recently been integrated or interfaced with each other to construct fully integrated modular laboratory automation. The considerations mentioned above suggest that the clinical laboratory automation and computer sciences have rendered non-analytical laboratory processes mostly manageable and standardized the automation technologies have added a serious impact on the proficiency of laboratory medicine. Clinical laboratory automation has improved such laboratory processes as specimen labeling, sorting, transport, processing, loading on the analyzers, analysis, storage, and archiving [2]. All are closely associated with both patient and healthcare staff safety and high-quality testing. adjective. 8. Some examples of analytical errors include equipment malfunction, procedures (i.e., standard operating procedures and assay instructions) not followed, undetected failure of quality control, sample mixups, and test interference. Errors in pathology and laboratory medicine: consequences and prevention. CLSI Approved Standard AUTO12-A. The pre-analytic testing phase occurs first in the laboratory process. Which of the following contains a chronologic record of a patients care? FOIA Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors. Careers. Sarkozi, L, Simson, E, Ramanathan, L. The effects of total laboratory automation on the management of a clinical chemistry laboratory. The implementation of non-analytical automated systems requires a risk management strategy based on laboratory's workflow and bottlenecks. official website and that any information you provide is encrypted Automated transport and sorting system in a large reference laboratory. Pre-analytical laboratory errors can arise throughout the pre-analytical phase, because this phase comprises a lot of manual activities and accounts for most of the errors encountered within the testing process as a whole. Thus, TAT improvement may be considered as a quality indicator (QI), a measure of laboratory performance. "Prevention of extra-analytical phase errors by non-analytical automation in clinical laboratory". 3. That adaptor may be considered as a local, automating toll. . Results shows that patient preparation, patient identification, specimen acquisition, specimen handling, and documentary system (specimen recording and result reporting) were important consideration factors. The most commonly reported types of pre-analytical error are: a) missing sample and/or test request, b) wrong or missing identification, c) contamination from infusion route, d) haemolysed, clotted, and insufficient samples, e) inappropriate containers, f) inappropriate blood to anticoagulant ratio, and g) . This work is licensed under the Creative Commons Attribution 4.0 International License. Public Health & Environmental Laboratories HHS Vulnerability Disclosure, Help The phlebotomist must use an adaptor for sampling and wait for complete filling of the tube vacuum. Post-analytical error rates were based on clear transcription errors resulting in the test result being incorrectly assigned to another test item. The mixing is a staff-dependent situation. Bonar R, Favaloro E, Zebeljan D, Rosenfeld D, Kershaw G, Mohammed S, Marsden K, Hertzberg M. Pathology. 2. I love to write and share science related Stuff Here on my Website. Klinik laboratuvar uygulamasnda, test srecindeki hatalar ncelikle ekstra analitik faz hata kaynaklar ile ilikilendirilir ve test sonu kalitesini derinden etkiler. Patient identification systems that use barcode technology also aid in correct identification of patient and specimen collection tubes. https://doi.org/10.1093/clinchem/48.10.1761.Search in Google Scholar, 33. We investigated the frequency of pre- and post-analytical errors by participants in the Royal College of Pathologists of Australasia (RCPA) Microbiology Quality Assurance Program (MQAP). Guder, W. Preanalytical factors and their influence on analytical quality specifications. Evaluation of needs and alternatives and development of a plan. Southeast Asian J Trop Med Public Health. Hawker, CD, Garr, SB, Hamilton, LT, Penrose, JR, Ashwood, ER, Weiss, RL. Ann Lab Med 2012;32:516. 8600 Rockville Pike Clin Chem 2002;48:175160. Automation and expert systems in core clinical chemistry. Of the 106 items where direct transposition errors were possible, 73 (69%) had at least one participant who transposed the results. In the late nineties, a body of evidence was accumulated which documented: a) a dramatic decrease in the analytical error rates from 162,116 errors per million laboratory tests (parts per million, ppm) to 447 ppm ( 5, 6 ); b) high rates of errors in the pre- and post-analytical steps ( 7-9 ); and c) the risk of adverse events and inappropriate c. Analytical errors in clinical laboratories as assessed by an Tube loader and sorter. Pre-analytical errors are those which arise before the samples are measured by laboratory professionals. The .gov means its official. 10. This guide provides key facts and practical tips on women's health. PDF Pre and postanalytical errors in haematology - Fondation Mrieux Laboratory errors: How to improve pre- and post-analytical phases PubMed, 37. Errors in pathology and laboratory medicine: consequences and prevention. Available from: http://gelecekmuhendislik.com/futurelab-labeler/ [Accessed Mar 2020].Search in Google Scholar, 16. Preanalytical investigations of phlebotomy: methodological aspects Adaptor usage for sampling may prevent insufficient sample. Your purchase has been completed. Delay in sample processing steps in laboratory. Dependent on inefficient mixing immediately after sampling. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). https://doi.org/10.1126/science.295.5554.517.Search in Google Scholar, 5. Methods: The tube labeler and preparer may lessen the errors associated with the bar-code labels low-resolution print quality, especially for outpatients. CLSI Approved Standard AUTO02-A2. TTP, total testing processes; PTS, pneumatic tube system; TAT, Turnaround time. The preanalytical phase comprises all of the processes occurring before the sample is processed in the autoanalyzer. The frequency and potential clinical impact of non-analytical errors in The management and standardization of non-analytical laboratory processes, especially of pre-analytical ones, have been primarily achieved thanks recently to automation, either by stand-alone devices or those integrated with analytical automation, as well as by informatics and computer sciences. Clinical and Laboratory Standards Institute. Review of Medical Errors in Laboratory Diagnostics and Where We Are