Clinical consequences of specimen rejection: a College of American Pathologists Q-Probes analysis of 78 clinical laboratories

Arch Pathol Lab Med. 2014 Aug;138(8):1003-8. doi: 10.5858/arpa.2013-0331-CP.


Context: Clinical laboratory specimens may be rejected as unsuitable for analysis for a variety of reasons and specimen rejection may have significant clinical consequences.

Objective: To quantify the clinical consequences of specimen rejection and determine the impact of laboratories' policies and practices on these consequences.

Design: Participants prospectively reviewed consecutive blood and urine specimens submitted to the chemistry and/or hematology laboratories to identify rejected specimens. For each rejected specimen, the patient's age, specimen type, testing priority, rejection reason, time from specimen receipt to receipt of recollected/relabeled specimen, recollection method, and test result time were recorded. Specimen/test abandonment was determined by failure to recollect or relabel a rejected specimen. Each laboratory's policy regarding relabeling of incorrectly labeled specimens was recorded, along with how many relabeled specimens were subsequently discovered to be mislabeled.

Results: Specimen rejection led to a (1) high rate of specimen recollection, (2) delay in result availability (median of 65 minutes), and (3) high rate of specimen/test abandonment. Longer test result delay was associated with higher hospital bed size; and higher test abandonment rate, with failure of the laboratory to request specimen recollection. Relabeling of incorrectly labeled specimens was found to be of little benefit and was associated with a substantial percentage of subsequently mislabeled specimens.

Conclusion: Specimen rejection has significant clinical consequences, including patient discomfort, significant delay in result availability, and high rate of specimen/test abandonment. Allowing routine relabeling of incorrectly labeled specimens is a dangerous practice, with little measureable benefit and with an increased risk to patient safety.

Publication types

  • Comparative Study

MeSH terms

  • Blood Chemical Analysis / standards*
  • Humans
  • Laboratories, Hospital / standards
  • Laboratory Proficiency Testing
  • Medical Errors / prevention & control*
  • Pathology / methods
  • Prospective Studies
  • Quality Improvement*
  • Societies, Medical
  • Specimen Handling
  • Terminology as Topic
  • Time Factors
  • United States
  • Urinalysis / standards*