"Pre-pre" and "post-post" analytical error: High-incidence patient safety hazards involving the clinical laboratory

Michael Laposata, Anand Dighe

Research output: Contribution to journalReview articlepeer-review

79 Scopus citations


Data from recent studies suggest that the highest incidence of laboratory-related errors occurs in the pre-analytical phase of laboratory testing. However, few studies have examined the frequency of errors in laboratory test selection and interpretation. A survey of physicians who use our clinical laboratory demonstrated that the largest number of test ordering errors appear to involve physicians simply ordering the wrong test. Diagnostic algorithms providing guidance for test selection in specific disorders are also used as the basis for the establishment of reflex protocols in the clinical laboratory. The provision of an expert-driven interpretation by laboratory professionals resulted in improvements both in the time to and the accuracy of diagnosis. A survey of our physician staff has shown that in the absence of such an interpretation, for patients being assessed for a coagulation disorder, approximately 75% of the cases would have involved some level of test result misinterpretation.

Original languageEnglish (US)
Pages (from-to)712-719
Number of pages8
JournalClinical Chemistry and Laboratory Medicine
Issue number6
StatePublished - Jun 1 2007
Externally publishedYes


  • Diagnostic algorithms
  • Laboratory errors
  • Patient safety
  • Post-analytical phase
  • Pre-analytical phase
  • Test interpretation
  • Test selection

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical


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