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'BD seeks to address fundamental weaknesses in developing world healthcare systems'

Recently, Becton, Dickinson and Company (BD) organised a seminar to help pathologists and lab diagnostic experts, improve specimen quality and subsequently patient care. M Neelam Kachhap spoke to Neeraj Raghuvanshi, Business Director, BD Diagnostics - Preanalytical Systems to find out more about their efforts.

What can you tell us about laboratory errors? Why should laboratories pay attention to pre-analytical systems?

Neeraj Raghuvanshi

There have been multiple publications analysing incidence and causes of errors in clinical laboratories. All of these indicate that pre-analytical phase contributes towards maximum number of errors. The human role in sample collection makes complete elimination of errors unrealistic. The analytical stage and post analytical stages depend primarily on the quality and integrity of the specimen received.

Can these errors be minimised and what percentages of laboratory errors can be avoided by pre-analytical systems?

Studies have indicated that nearly 68 per cent of all errors in laboratory testing are associated with the pre-analytical phase – phlebotomy (blood collection) being a major component of this phase. The major pre-analytical errors associated with phlebotomy include haemolysis, patient identification, insufficient sample volume, incorrect additive, and improper clotting, training phlebotomists on best practices has shown to help in reducing pre-analytical errors.

What are the economical impact of such errors? Error costs as a percentage of total hospital costs ?

The cost of laboratory services represent about five per cent of the total healthcare costs, the results generated in the laboratories are responsible for about 70 per cent of medical decisions made in the hospitals (Advance Lab Magazine, July 2005; Forsman Rodney S. The Value of the Laboratory Professional in the Continuum of Care. Clinical leadership and management review, 370-373 Nov/Dec, 2002). The devices used in blood collection contribute about five per cent of the total laboratory costs. Good practices and compliance in blood collection can significantly reduce pre-analytical errors and laboratory costs. Pre-analytical errors can contribute to costs by impacting:

  • Quality of patient care –erroneous medical diagnosis, and delayed medical intervention
  • Safety—needle stick injuries to patients or staff and hence raising risk of transmitting blood borne pathogens
  • Time— increased turnaround time and repeat sample collection
  • Resources and Budget – reduced staff and equipment efficiency
  • Reputation of the facility in overall healthcare delivery

What is the effect on patient outcome?

It is estimated that 70-85 per cent of clinical decisions are based upon information derived from laboratory test results (Foubister, Vida. Cap Today Bench press: The Technologist/technician shortfall is putting the squeeze on laboratories nationwide; September 2000; Datta, P Resolving Discordant Samples. Advance for the Administrators of the Laboratories; July 2005: p 60), so ensuring optimal sample quality is crucial to the patient, clinician and the efficiency of the hospital. Comprehensive quality control program, along with pre-analytical awareness and training can prove to be valuable tools to improve specimen quality and, subsequently, patient care.

What is the scene of pre-analytical systems in Indian laboratories?

There are no defined guidelines for specimen collection in India. Since accreditation of laboratories is voluntary (rather than mandatory), only a small percentage of laboratories are accredited. The accredited laboratories give high importance to pre-analytical phase. Such clinical laboratories, like other parts of our healthcare system, are striving to provide high-quality services in the face of ever-shrinking resources and increasing regulatory demands. Lab directors and managers are viewing the pre-analytical phase of laboratory testing as a critical area for improvement that can drive not only better patient care and satisfaction, but also productivity gains and cost savings.

What is BD's investment in pre-analytical systems?

BD’s lab strengthening programme is exceptional in its comprehensive approach to transferring knowledge, technology and expertise to the developing world through a combination of hands-on training workshops, and the provision of equipment. By investing in lab strengthening, BD seeks to address fundamental weaknesses in developing world healthcare systems. In India, BD has designed pre-analytical audits (May I Help You) to help laboratories across the country to identify gaps in their practices as compared to international guidelines. Through this tool, laboratories are able to prepare a step by step approach to make improvements in their practices. Further, the content and methodology used in BD phlebotomy training programmes have been endorsed by Association of Clinical Biochemists of India (ACBI) and is widely accepted by laboratory professionals throughout the country.

How will this space change in the future and how will BD keep pace with this changing environment?

For more than 60 years, BD has advanced the science of specimen collection that has helped enable laboratory tests to become the foundation for 70 per cent of all medical decisions.(The Lewin Group (2005). The Value of Diagnostics: Innovation, Adoption, and Diffusion into Health Care, Published for the Advanced Medical Technology Association, pg 1)

Today, the gold standard in sample collection is the BD Vacutainer product family, which leading hospitals rely upon to enhance sample quality and protect their nurses, phlebotomists and other caregivers from costly accidental needle-stick injuries. These products, backed by unrivalled customer support and training, help hospitals everyday to enhance lab productivity and work-flow by reducing retests, recollects and instrument downtime.

During the last ten years, BD in India has put tremendous efforts towards increasing the awareness of laboratory personnel in better and safer blood collection practices. Every year BD India conducts more than 1000 training programmes for healthcare workers training close to 10000 healthcare workers in a year on best practices in blood collection.

BD Laboratory Consulting Services works as a partner in obtaining pre-analytical excellence through sustainable education and training solutions. The customised training programmes deliver the skills and knowledge laboratory staff needs to reduce costly pre-analytical errors and help achieve the critical organisational goals and objectives of enhancing quality and improving productivity and reducing costs.


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