SPECIMEN REJECTION REPORT DEPARTMENT OF PATHOLOGY, HOSPITAL SHAH ALAM
Assessment of specimen rejection rates is an important laboratory quality measure for laboratories because of a potential negative impact on patient care. Clinical specimens received by laboratory may be rejected for a variety of reasons, which may have substantial clinical consequences for patient safety. Specimen rejection leads to: i. inconvenience and discomfort of repeated specimen collection ii. delay in reporting test results iii. abandonment of tests Laboratory specimen rejection rates are expressed as a percentage of specimen rejections. The Malaysian Society for Quality in Health (MSQH) in its 2022 6 th edition of the MSQH Hospital Accreditation Standardsrecommended a rejection rate of less than 1% as one of the quality performance indicators for the Pathology Service. DEPARTMENT OF PATHOLOGY HOSPITAL SHAH ALAM 2023
2023 Department of Pathology Hospital Shah Alam JUNE 2023 SPECIMEN REJECTION REPORT
Page 1 of 10 • TOTAL SPECIMEN RECEIVED VS. NUMBER OF REJECTED SPECIMEN o JANUARY – MARCH 2023 SPECIMEN REJECTION RATE (STANDARD <1%) o JANUARY – MARCH 2023 1,882 2,133 2,390 58,431 59,429 65,713 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 JAN FEB MAR NO. OF SPECIMEN DEPARTMENT OF PATHOLOGY TOTAL SPECIMEN RECEIVED VS. NO. OF REJECTION JAN - MAR 2023 NO. OF REJECTION TOTAL SPECIMEN RECEIVED 3.2 3.6 3.6 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 JANUARY FEBRUARY MARCH REJECTION RATE (%) DEPARTMENT OF PATHOLOGY REJECTION RATE JAN-MAR 2023
Page 2 of 10 • TOTAL SPECIMEN RECEIVED VS. NUMBER OF REJECTED SPECIMEN o OUTPATIENT/SPECIALIST CLINICS NO. OF REJECTED SPECIMENS JAN FEB MAR 122 76 92 7479 7285 7742 21 43 27 1096 1282 1465 1 0 2 269 121 342 36 21 55 941 1136 934 487 552 569 14880 15760 16940 2 4 5 181 193 187 11 19 17 424 382 475 10 2 16 375 250 320 7 14 27 438 416 583 104 97 131 4340 3925 3976 0 0 0 5 0 0 2 2 2 105 72 102 1 0 0 17 19 1 0 0 0 12 1 19 1 0 0 21 7 19 0 2 0 12 15 16 0 5 0 113 182 305 8 18 49 591 796 1062 ANAES THESIOLOGY MORTUARY KLINIC WARGA PSYCHIATRY O&G NEUROSURGERY ORAL SURGERY PAEDS DENTAL NEPHROLOGY EMERGENCY OBSERVATION ED ORTHOPAEDIC ORL OPHTHALMOLOGY MEDICAL PAEDIATRIC HEMODIALYSIS SURGICAL OUTPATIENT / SPECIALIST CLINIC TOTAL SPECIMEN RECEIVED
Page 3 of 10 o INPATIENTS/WARDS NO. OF REJECTED SPECIMENS JAN FEB MAR 78 139 125 2202 2200 2459 19 54 75 578 787 915 40 29 24 1203 1287 1369 29 44 47 914 1139 1228 51 52 53 1205 1194 1301 40 54 60 1135 1425 1280 39 46 39 1926 2036 2276 21 15 16 704 533 610 113 114 178 2723 2413 3057 100 166 168 2493 2742 2723 120 150 129 2746 2699 3184 126 125 136 2831 2618 2934 68 60 68 1336 1291 1580 83 61 102 1474 1417 1757 55 67 87 1196 1243 1462 12 36 28 546 707 781 8 7 10 172 132 172 WARD MULTIDISCIPLINE (SURGICAL) L13 WARD MULTIDISCIPLINE L3 (MDW) MEDICAL/SURGICAL DAYCARE WARDS TOTAL SPECIMEN RECEIVED WARD MEDICAL 9B WARD MEDICAL 10A WARD MEDICAL 10B WARD MULTIDISCIPLINE (ORTHO) L11 WARD MULTIDISCIPLINE (SURGICAL) L6 WARD O&G 8A WARD O&G 8B NEWBORN (NB01) CCU WARD MEDICAL 9A NICU WARD 12 PAEDIATRIC ICU HDW
Page 4 of 10 • REJECTION RATE ACCORDING TO LOCATION o OUTPATIENT/SPECIALIST CLINICS & INPATIENT/WARDS 1.6 1.9 0.4 3.8 3.3 1.1 2.6 2.7 1.6 2.4 0.0 1.9 5.9 0.0 4.8 0.0 0.0 1.4 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 REJECTION RATE (%) REJECTION RATE JANUARY 2023 OUTPATIENT/SPECIALIST CLINICS 3.5 3.3 3.3 3.2 4.2 3.5 2.0 3.0 4.1 4.0 4.4 4.5 5.1 5.6 4.6 2.2 4.7 0.0 1.0 2.0 3.0 4.0 5.0 6.0 REJECTION RATE (%) REJECTION RATE JANUARY 2023 INPATIENTS/WARDS
Page 5 of 10 1.0 3.4 0.0 1.8 3.5 2.1 5.0 0.8 3.4 2.5 0.0 2.8 0.0 0.0 0.0 13.3 2.7 2.3 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 REJECTION RATE (%) REJECTION RATE FEBRUARY 2023 OUTPATIENT/SPECIALIST CLINICS 6.3 6.9 2.3 3.9 4.4 3.8 2.3 2.8 4.7 6.1 5.6 4.8 4.6 4.3 5.4 5.1 5.3 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 REJECTION RATE (%) REJECTION RATE FEBRUARY 2023 INPATIENTS/WARDS
Page 6 of 10 1.2 1.8 0.6 5.9 3.4 2.7 3.6 5.0 4.6 3.3 0.0 2.0 0.0 0.0 0.0 0.0 0.0 4.6 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 REJECTION RATE (%) REJECTION RATE MARCH 2023 OUTPATIENT/SPECIALIST CLINICS 5.1 8.2 1.8 3.8 4.1 4.7 1.7 2.6 5.8 6.2 4.1 4.6 4.3 5.8 6.0 3.6 5.8 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 REJECTION RATE (%) REJECTION RATE MARCH 2023 INPATIENTS/WARDS
Page 7 of 10 • REASONS OF REJECTION ACCORDING TO TYPE OF TESTS o CHEMICAL PATHOLOGY TESTS o HAEMATOLOGY TESTS 928 389 361 182 156 136 98 84 81 75 48 30 22 19 15 15 14 13 10 10 8 8 7 3 3 3 1 0 100 200 300 400 500 600 700 800 900 1000 NO. OF SPECIMEN REASONS OF REJECTION JAN-MAR 2023 CHEMICAL PATHOLOGY TESTS 876 447 173 154 126 56 51 43 33 18 13 12 7 6 5 4 3 3 3 3 2 1 1 1 1 1 0 100 200 300 400 500 600 700 800 900 1000 NO. OF SPECIMEN REASONS OF REJECTION JAN-MAR 2023 HAEMATOLOGY TESTS
Page 8 of 10 o MICROBIOLOGY TESTS o TRANSFUSION TESTS 171 79 29 19 9 6 4 3 2 2 1 1 1 1 0 20 40 60 80 100 120 140 160 180 NO. OF SPECIMEN REASONS OF REJECTION JAN-MAR 2023 TRANSFUSION TESTS 303 209 109 93 78 68 55 48 41 29 25 23 22 20 14 10 9 9 8 6 6 5 5 4 4 4 2 2 1 1 1 1 0 50 100 150 200 250 300 350 NO. OF SPECIMEN REASONS OF REJECTION JAN-MAR 2023 MICROBIOLOGY TESTS
Page 9 of 10 o HISTOPATHOLOGY TESTS o CYTOLOGY TESTS 80 7 2 2 1 1 1 0 10 20 30 40 50 60 70 80 90 Duplicate order Wrong labelling Wrong order Discrepancy specimen label and form Order cancelled by doctor Incomplete form Specimen leakage/broken/spill NO. OF SPECIMEN REASONS OF REJECTION JAN-MAR 2023 HISTOPATHOLOGY TESTS 8 7 3 3 1 1 REASONS OF REJECTION JAN-MAR 2023 CYTOLOGY TESTS No request form attached Specimen leakage/broken/spill Duplicate order Specimen not labelled Wrong labelling Discrepancy specimen label and form
Page 10 of 10 **SOURCE OF DATA: LAB INFORMATION SYSTEM (LIS), HSAS Blood hemolysed 29% Blood clotted 20% Insufficient sample 9% Duplicate order 7% No clinical history 5% Wrong container 4% Specimen leakage/broken/spill 3% No MO code received 3% Incorrect sample volume 3% No clinical indication 3% Wrong order 2% No request form attached 2% Others 10% Other 20% OVERALL REASONS OF REJECTION JAN-MAR 2023