Evaluation of Specimen Rejection Rates in the Preanalytical Phase and Nurses' Experiences: A Mixed Design Study

Evaluation of Specimen Rejection Rates in the Preanalytical Phase and Nurses' Experiences: A Mixed Design Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Specimen Rejection Rates in the Preanalytical Phase and Nurses' Experiences: A Mixed Design Study Yasemin GÜNER, Elif KILIÇ GÜNER, Melek ÜÇÜNCÜOĞLU, Harun YÜKSEL This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5856592/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted 4 You are reading this latest preprint version Abstract Background Aim of the study was to examine the rejection rates of specimens in the preanalytical phase and to determine the experiences of nurses. Methods A mixed design was used in the study, combining retrospective data analysis and individual in-depth interviews. First, data on specimens rejection reported by microbiology and biochemistry laboratories were collected for one year. Then, individual in-depth interviews were conducted with nurses working in the clinics with the highest specimens rejection rates. Results As a result of the study, three main themes were determined: the functioning of the preanalytical phase, the causes of medical errors in the preanalytical phase, and the impact of the preanalytical phase on the well-being of nurses. Conclusion These results, institutional factors, patient profiles, stakeholders involved in the phase, and the clinical environment all affect the preanalytical phase, potentially leading to medical errors; this phase also affects the attitudes and behaviors of patients and their relatives, and the well-being of nurses, causing emotional fatigue. Despite these difficulties, nurses strive to protect their well-being and provide emotional support to patients and their families. Based on the findings of our study, there is a need for strategies focused on ensuring the well-being of nurses, and reducing emotional fatigue. Clinical trial number: Not applicaple. error prevention preanalytical phase patient safety nursing medical error Figures Figure 1 Introduction Clinical laboratories play a vital role in ensuring patient safety ( 1 ). The American College of Pathology highlighted the importance of laboratory safety as early as 1946 ( 2 ). Laboratory tests provide essential information that influences diagnostic and therapeutic decisions, ( 3 ) with an estimated 60–70% of these decisions relying on test results ( 4 ). As a result, laboratory tests are an indispensable part of modern clinical diagnosis ( 5 ). The laboratory testing phase consists of three main phases: pre-analytical, analytical, and post-analytical. The pre-analytical phase is the most error-prone, accounting for 70% of all laboratory errors. This phase includes ordering the correct test for the patient, collecting the specimen, transporting it, and preparing it for analysis( 6 ). Errors in the pre-analytical phase can harm the institution's reputation, erode trust in healthcare services, increase overall costs for the laboratory and hospital, and negatively impact the institution's financial situation. Furthermore, errors in the pre-analytical phase increase the overall costs for the laboratory and the hospital, thereby negatively affecting the institution's financial capacity. Improving laboratory processes can thus contribute positively to disease prevention, diagnosis, treatment, clinical monitoring, and the reduction of operating costs ( 1 , 5 ). Nurses were chosen for these interviews because they are primarily responsible for the sampling during the pre-analytical phase and play a key role in communicating between patients and the healthcare team ( 7 ). Our study aims to examine the rejection rates of specimens during the preanalytical phase over the past year and to reveal the reasons behind sample specimen and determine the experiences of nurses through individual, in-depth interviews with nurses from relevant units. Methods Design This mixed-methods study was designed to combine both quantitative and qualitative research approaches, utilizing retrospective data analysis and individual in-depth interviews. The research was conducted at a tertiary university hospital with a capacity of 832 beds, employing approximately 800 nurses and 900 physicians. The hospital also provides education, research, and health services, making it a comprehensive setting for the study. Participants and setting : The study was carried out in two stages. In the first stage, data on specimen rejections from the microbiology and biochemistry laboratories were collected over a one-year period (from October 1, 2022, to September 30, 2023). The specimens were evaluated based on the laboratory reports submitted to the indicator management system, which adheres to the Ministry of Health Quality and Performance Directive for Laboratory Safety. The rejected specimens were identified using the Ministry of Health Laboratory Errors Classification System-Code Table. Specimen rejection data were collected from various units, including outpatient blood collection units (adult and pediatric), emergency departments, intensive care units, and inpatient wards (pediatric and adult). The units were categorized into four groups: internal units, surgical units, specialized units, and pediatric units. In the second stage of the study, individual in-depth interviews were conducted with nurses from the identified units with the highest rates of specimen rejections. The study involved 16 nurses who volunteered to participate. Data Collection For the data collection in the second stage, a purposive sampling method was employed. Individual in-depth interviews were carried out with the 16 nurses working in the units with the highest specimen rejection rates. The interviews were conducted until data saturation was reached, meaning that no new information was obtained from subsequent interviews. Each interview lasted approximately 45 minutes and was conducted face-to-face using semi-structured questions. The interviews were audio recorded for later transcription and analysis. Data Analysis Quantitative data were analyzed using descriptive statistics, with qualitative variables presented as frequencies. For qualitative data, the audio recordings from the individual in-depth interviews, obtained with voluntary consent, were transcribed using the 'Transcriber' application. The resulting texts were verified by the researchers (XX) who conducted the interviews, ensuring accuracy by cross-checking the transcripts against the original audio recordings. Participants' identities were protected by assigning each a code name in the transcriptions. Thematic analysis was employed to analyze the qualitative data ( 8 ). The researchers independently reviewed the transcripts, considering the research questions and sub-questions, to generate initial codes. They convened in joint meetings to reconcile and agree upon these initial codes. Following this agreement, the researchers collaboratively categorized and thematized the codes, finalizing the analysis of the qualitative data. Trustworthiness The study utilized several strategies to ensure trustworthiness. Validity was enhanced by continuing the interviews until data saturation was reached, and by combining both quantitative and qualitative data to validate the findings. Transferability was ensured by providing detailed descriptions of the setting and participants, allowing the results to be applicable in similar contexts. Dependability was ensured by documenting the research process clearly and applying consistent data collection methods. Finally, confirmability was achieved by maintaining an audit trail and using peer debriefing to minimize researcher bias and ensure objectivity ( 9 ). These strategies contributed to the overall trustworthiness of the study’s findings. Ethical issues Ethics committee approval numbered E-69268593-050.02.21421 was gave for by “Ethical committee of scientific research of XXX” the study. Results Quantitative data According to the study results, 14290 samples were rejected in the biochemistry laboratory and 4220 specimens were rejected in the microbiology laboratory in a one-year period (Table 1 , Table 2 ). When Specimen rejections were examined in terms of units, the highest number of Specimen rejections in the biochemistry and microbiology laboratories occurred in internal units (Table 1 , Table 2 ). Table 1 Causes for specimen rejection by units in the microbiology laboratory within one year Internal Units Surgical Units Specialized Units Pediatric Units Total (n) (n) (n) (n) (n) Incorrect Test Order (L01) 214 166 106 50 536 Missing/Incorrect Information in the Test Order (L02) 9 0 3 3 15 Unregistered sample (L04) 0 0 1 0 1 Incorrect Registration (L05) 15 3 13 5 36 Sampling from the Wrong Patient (L06) 1 8 38 13 60 Misidentified Specimen (L07) 4 1 9 1 15 Lost Specimen (L08) 3 3 1 0 7 Recollected Specimen (L09) 13 3 3 19 38 Incorrect Specimen Container/Tube (L10) 71 31 45 13 160 Empty Specimen Container/Tube (No Specimen Inside) (L11) 42 8 13 11 74 Cancellation of Registration Due to Failure to Collect the Specimen from the Patient (L14) 2 0 1 1 4 Improperly Collected Specimen (L15) 126 55 85 20 286 Insufficient Specimen (L16) 496 182 316 466 1460 Hemolyzed Specimen (L17) 34 32 54 22 1299 Clotted Specimen (L18) 277 256 424 342 1299 Lipemic Specimen (L19) 4 1 3 2 10 Sampling time not recorded (L22) 0 0 0 1 1 Specimen not delivered to the laboratory (L23) 1 0 2 0 3 Inappropriate transfer conditions (L24) 2 1 15 3 21 Exceeding the specified maximum specimen transfer time (L25) 1 0 0 0 1 Mixing of specimens (L26) 1 0 0 1 2 Acceptance of rejected specimen (L27) 2 0 1 0 3 Improperly stored specimen (L29) 4 1 1 0 6 Non-arrival of requested material/kit (L32) 0 0 0 1 1 Device pipetting error (L40) 2 0 0 0 2 Failure to comply with test run procedures (L42) 6 13 1 0 20 Incorrect technical approval (L53) 1 0 0 0 1 Result not delivered on time (L57) 11 1 2 2 16 Total 1342 765 1137 976 4220 Table 2 Causes for specimen rejection by units in the biochemistry laboratory within one year Internal Units Surgical Units Specialized Units Pediatric Units Total (n) (n) (n) (n) (n) Incorrect Test Orders (L1) 48 17 49 11 125 Missing/Incorrect Information in the Test Order (L02) 19 2 4 5 30 Incorrect Registration (L05) 16 6 9 10 41 Sampling from the Wrong Patient (L06) 8 9 50 27 94 Misidentified Specimen (L07) 2 0 10 2 14 Lost Specimen (L08) 17 4 1 1 23 Recollected Specimen (L09) 23 6 4 18 51 Incorrect Specimen Container/Tube (L10) 266 94 101 40 501 Empty Specimen Container/Tube (No Specimen Inside) (L11) 41 19 34 13 107 Cancellation of Registration Due to Failure to Collect the Specimen from the Patient (L14) 2 0 1 0 3 Improperly Collected Specimen (L15) 372 182 310 87 951 Insufficient Specimen (L16) 2149 760 992 1670 5571 Hemolyzed Specimen (L17) 161 152 388 82 783 Clotted Specimen (L18) 1473 1081 1903 1258 5715 Lipemic Specimen (L19) 8 6 19 19 52 Specimen not delivered to the laboratory (L23) 1 0 0 0 1 Inappropriate transfer conditions (L24) 21 6 66 13 106 Exceeding the specified maximum specimen transfer time (L25) 0 0 0 2 2 Mixing of specimens (L26) 1 0 0 2 3 Acceptance of rejected specimen (L27) 0 0 1 1 2 Automation malfunction (L28) 0 2 0 0 2 Improperly stored specimen (L29) 13 7 2 3 25 Non-arrival of requested material/kit (L32) 1 0 0 1 2 Inappropriate transfer conditions (L34) 0 0 1 0 1 Device pipetting error (L40) 1 3 0 0 4 Insufficient homogenization of the specimen (L41) 2 2 1 1 6 Result not delivered on time (L57) 32 9 4 11 58 Total 4687 2369 3953 3281 14290 The most common Specimen rejection reasons in the biochemistry laboratory were insufficient Specimen (5571), hemolyzed specimen (783), coagulated specimen (5715) and (Table 1 ). In the microbiology laboratory, the most common sample rejection reasons, similar to the biochemistry laboratory, were insufficient specimen (1460), hemolyzed specimen (1299) and coagulated specimen (1299) (Table 2 ). Qualitative data As a result of the qualitative data analysis from our study, three main themes emerged: The preanalytical phase, the causes of medical errors within this phase, and the impact of the preanalytical phase on the well-being of nurses (Table 3 ). Table 3 Quotations related to the themes that emerged in our study Themes Theme 1: The Functioning of the Preanalytical Phase Steps Applied in the Preanalytical Phase “The blood collection phase starts when the doctor places the order. Then, the tubes are prepared, barcoded, and the blood is drawn (N1).” “We can take blood from patients in the clinic, during their initial admission, or while preparing for surgery (N5).” Nurses' Reasons for Specimen Rejection “... Rejection can happen if blood tubes are underfilled or overfilled. This causes problems for both the patient and us... (N4)” “Most of the time, we find out about a specimen rejection from a notification on the computer screen, or they call us when there's a critical value (N7).” “... The system reflects when specimens are rejected. Sometimes there's clotting because the blood wasn't collected properly, and sometimes we can't fill the tube enough, especially in difficult cases like pediatric patients, and it gets reported as an insufficient specimen (N8).” “When following up on patients' results, you notice a huge difference between the blood test results from one day to the next. Of course, this doesn't match the patient's clinical condition... In such cases, we recollect the specimen and find out that the original result wasn't actually from that patient... (N16).” Theme 2: Causes of Medical Errors in the Preanalytical Phase Stakeholder-Related Causes “Patients are often seen as tasks to be completed because we are understaffed and always rushing to get things done. This leaves us open to making mistakes (N3).” “In the morning, all the barcoded blood tubes for the patients are left on the treatment cart and collected one by one. There were two patients with the same name. I picked up the tube and took blood from a patient. Later, my colleague started looking for a blood tube, and we realized I had taken blood from the wrong patient. I immediately disposed of the incorrect tubes and took the correct specimens from the right patient... (N9).” “When babies are monitored in incubators, the identifier is attached to the incubator because the skin on their arms is delicate. This can cause problems (N10).” “We enter the blood specimens into the system at night to avoid difficulties in the morning. The fatigue from night shifts makes us prone to errors (N11).” “Experience is crucial in the blood collection phase. For example, new colleagues sometimes can't manage the phase (N14).” Clinical Setting-Related Causes “I would like to collect blood in one go, but there are so many patients, so we need to hurry. The environment is stressful, and if we don't get it right the first time, the patient’s relatives complain, and it causes stress... (N6).” “Think about it; we collect blood from over five hundred patients. It’s crowded, and sometimes patients can’t hear you calling them because of the noise... (N12).” Patient Profile-Related Causes “Patients are often absentminded, probably because the hospital environment exhausts them. They come with the wrong tube; you call out the name written on it; they nod, but then you find out they’re the wrong patient... (N2).” “Patients' existing medical conditions can affect the blood collection phase, for example, patients with clotting disorders or those undergoing cancer treatment... (N13).” “It’s harder to draw blood from children than adults due to their vein structure, their behavior, and pressure from their families... (N15).” Institution-Related Causes “When we have issues with patients' relatives and the institution doesn’t support us, it makes us feel undervalued. All we want is for them to acknowledge that we are human too... (N6).” “Unfortunately, our workload is too heavy. Sometimes, we send blood specimens via courier, but occasionally the specimens sit there because the courier is away (transporting a patient elsewhere). I rush to the lab to deliver the specimens so the patient isn't affected (N7).” “We learned the blood collection phase during our undergraduate studies, then from more experienced colleagues. We haven't received specific training on what to pay attention to (N11).” Theme 3: The Effect of the Preanalytical Phase on Nurses' Well-being Nurses' Emotional Fatigue “I feel sad and worthless when I do not receive support from my institution in the face of patient complaints. We expect to be understood a little bit. I think we have a demanding profession (N10).” “Pediatric patients often involve handling sensitive parents. Blood collection in children can be challenging, and I sometimes need to squeeze the child's hand to encourage blood flow from the back of the hand. The situation is often stressful, as children may cry and parents might express impatience, asking if the procedure is done yet, which causes pressure (N12).” “ Well, we try to explain and make them understand. It's a stressful phase, it's a difficult phase. Working there requires patience (N16).” Patient and Family Attitudes Toward Nurses “Sometimes we have trouble collecting blood, and patients can get angry and react even more when we have to try again. In the following days, they often remind us that we couldn't do it last time (N1).” “Most of the babies we see are premature, and their mothers understandably get upset when they see bruises on their babies' hands or arms after procedures like drawing blood (N5).” “...Very rarely do patients choose to be understanding. Often, they leave saying, 'I will complain about you.' I understand they're upset, but we're human beings too (N13).” Providing Emotional Support to Patients and Families “I don't rush when approaching the patient; I ask questions and always try to create a more relaxed atmosphere (N8). “When we need to draw blood again, patients and their relatives often react by asking why we need to collect more blood, especially if we've just done it. In these situations, I try to explain the reasons and calm them down (N9).” Nurses' efforts to maintain their well-being “We nurses are always the ones solving problems, whether it's ensuring blood specimens are delivered or communicating with the lab if there's an issue... (N3).” “It requires professionalism and understanding the patient. You have to understand the child as well, and that's always the perspective you approach it from (N14).” Theme 1: The Functioning of the Preanalytical Phase Steps Applied in the Preanalytical Phase: The nurses described the steps involved in the preanalytical phase as follows: Initially, a blood order is made through the computer system. Following this, the necessary tubes or containers for sampling are prepared. The tubes or containers are then barcoded, either manually or by using a device. Blood is then collected from the patient, and the barcodes are scanned. Finally, the specimens are sent to the laboratory, typically via a pneumatic system or through email notification. Nurses' Reasons for Specimen Rejection:Nurses mentioned several reasons for rejecting specimens: clotted specimens, incorrect barcoding, collecting blood from the wrong patient, lost specimens, insufficient specimen volume, incorrect registration in the system, barcode stickers not sticking properly (due to poor-quality materials), and hemolysis. Healthcare Professionals ' Noticing Specimen Rejection: The nurses noticed specimen rejections when the patient's blood results didn't match their clinical condition when the lab notified them, when they suspected the results, when there was a delay in getting the results, or when there was an alert about critical values. Theme 2: Causes of Medical Errors in the Preanalytical Phase Stakeholder-Related Causes:In our study, several causes related to healthcare professionals were identified as causes of medical errors. These include incorrect patient identification, unclear responsibilities, lack of experience, improper handling of administrative phases, incorrect techniques in drawing blood, rushing the blood collection phase, delays in blood collection, delays in delivering blood to the laboratory, communication breakdowns between laboratories and clinics, lack of empathy, and entering blood specimens into the system during night shifts. Clinical Setting-Related Causes: In our study, several factors related to the clinical setting were identified as contributing to medical errors. These include a great number of patients, rapid patient turnover, a noisy environment, and a generally stressful work setting. Patient Profile-Related Causes:Patient-related factors contributing to errors were identified as cognitive impairment, the patient's age group, existing medical conditions, and special needs. Institution-Related Causes:Institutional factors identified in our study include unclear job descriptions, excessive workload, lack of in-service training in the preanalytical phase, lack of institutional support, and insufficient time allocated to patients. Recommendations for the Healthy Operation of the Preanalytical Phase and Prevention of Medical Errors Recommendations for Institutions: The nurses in our study provided several recommendations to institutions for ensuring the smooth operation of the preanalytical phase and preventing medical errors. They recommended streamlining the blood collection phase by using a single source of data, to avoid placing patients with the same name in the same room to prevent identity confusion, to verify patient identity along with the importance of informing staff about the patient's name and surname during blood orders, to verify patient identity information during the secretarial phase, to increase the number of healthcare professionals, provide training specific to the preanalytical phase, and involve experienced healthcare professionals, to establish a dedicated blood collection team (including a pediatric nurse), to reduce waiting times in the laboratory, to have two people check the blood and avoid rushing the blood draw. Recommendations for Device Manufacturers: Nurses also offered suggestions to device manufacturers to support the preanalytical phase and reduce medical errors. They recommended developing devices that can easily visualize vascular structures, creating devices that require fewer specimen quantities, making pediatric tubes smaller, and designing pediatric machines that are more sensitive and capable of working with minimal specimen amounts. Theme 3: The Effect of the Preanalytical Phase on Nurses' Well-being Nurses' Emotional Fatigue: The study revealed that nurses experience significant emotional strain during the preanalytical phase. They reported feeling psychological pressure, helplessness, negative self-perception, damage to their professional dignity, a loss of motivation, a sense of worthlessness, anxiety, remorse, and a deep sense of empathy for their patients. Patient and Family Attitudes Toward Nurses: The study found that patients and their families often exhibit various attitudes toward nurses during the preanalytical phase like anger, questioning the nurse's professionalism, frustration, filing complaints with management, verbal abuse, judgment, reacting negatively, being understanding, trusting, questioning, and expressing discomfort. Providing Emotional Support to Patients and Families: In our study, it was observed that during the preanalytical phase, nurses tended to explain the situation to patients and their relatives, avoid rushing, try to express themselves clearly, be patient, wait for patients and their relatives to calm down, and work to soothe the patients. Nurses' efforts to maintain their well-being:In our study, nurses employed various coping mechanisms to maintain their well-being, like consciously reminding themselves to be patient, trying to understand patients and their families, striving to uphold professionalism, listening to patients, communicating with the laboratory in case of specimen rejection, and finding solutions to ensure the timely delivery of specimens to the lab. Discussion Our study aims to examine the rejection rates of specimens during the preanalytical phase over the past year and to reveal the reasons behind sample specimen and determine the experiences of nurses through individual, in-depth interviews with nurses from relevant units. Functioning of the Preanalytical Phase The nurses detailed the steps involved in the preanalytical phase, highlighted the reasons for specimen rejection, and described how they noticed issues with the specimens. Our findings indicate that the most common causes for specimen rejection, as reported by the hospital's indicator management system, were insufficient, hemolyzed and clotted specimens. In addition, the highest rate of specimen rejection in the biochemistry laboratory and microbiology laboratory were in internal unit. Nurses in our study cited clotted specimens, incorrect barcoding, blood collection from the wrong patient, specimen loss, insufficient specimen volume, data registration omissions in the system, non-adhering barcodes (due to poor quality materials), and hemolysis as the primary causes of specimen rejection. Similar findings have been reported in other studies, where common causes for specimen rejection include incomplete specimen and/or test orders, incorrect or incomplete patient identification, contamination from infusion routes, hemolyzed, clotted, and insufficient specimens, inappropriate containers, incorrect blood/anticoagulant ratios, and improper transport and storage conditions ( 10 – 12 ). Additionally, the nurses mentioned that they often realized a specimen had been rejected when there was a discrepancy between the patient’s blood test results and their clinical presentation, or when the laboratory notified them of an issue. In our study, it was observed that most errors are detected only after the specimen reaches the laboratory. While these errors are identified before they directly impact patient care, they pose a significant risk of leading to misdiagnosis and incorrect treatment, emphasizing the need for precautionary measures. Causes of Medical Errors in the Preanalytical Phase We identified several factors contributing to medical errors in the preanalytical phase, including those related to stakeholders, the clinical setting, patient profiles, and administrative factors. The preanalytical phase, a critical component of laboratory diagnostics, encompasses patient preparation, specimen collection, transport, preparation, and storage ( 13 ). According to our findings, numerous preventable factors influence the preanalytical phase, consistent with relevant literature. The study highlighted several causes of medical errors linked to healthcare professionals, such as improper patient identification, unclear responsibilities, lack of experience, improper management of the secretarial phase, incorrect blood collection techniques, haste in blood collection, prolonged collection procedures, delays in transporting blood to the laboratory, communication breakdowns between the laboratory and clinical staff, and the practice of ordering blood work during night shifts. One study underscored the importance of effective patient identification in the preanalytical phase as a critical point where errors can occur ( 14 ). Another study emphasized the challenges related to the transfer of specimens post-collection, indicating that mishandling during this phase can lead to significant diagnostic inaccuracies ( 15 ). Maintaining effective dynamics and strengthening communication among healthcare professionals is crucial in preventing medical errors. Enhancing the technical and non-technical skills of healthcare workers is essential for improving the preanalytical phase. In our study, factors related to the clinical setting contributing to medical errors included a high patient load and turnover, noise, and a stressful working environment. Previous research has shown a positive relationship between sufficient staffing levels, effective cooperation between nurses and physicians, management support, and patient safety ( 16 ). Another study identified intense workload and insufficient professional skills as the most significant stressors among healthcare professionals ( 17 , 18 ). Improving the working conditions for nurses, therefore, could significantly enhance patient safety. Additionally, patient-related factors identified in our study, such as perception disorders, age groups, and existing medical conditions, were found to impact the preanalytical phase. Nurses need specialized training in managing care for individuals with special needs. The literature also emphasizes that patients and their families play a critical role in ensuring patient safety ( 17 ). In our study, institutional factors contributing to medical errors included unclear job descriptions, intense workloads, lack of in-service training in the preanalytical phase, insufficient institutional support, and inadequate time allocated to patient care. A study by Assegu Fenta et al. highlighted poor management support and heavy workloads as key factors affecting the preanalytical phase ( 19 ). Another study demonstrated that institutional support can significantly reduce medical errors ( 20 ). The literature offers various guidelines and policy recommendations to provide such support ( 21 ). Institutions bear a significant responsibility in improving the preanalytical phase, including the human factors involved, assessing the quality of training programs, and conducting root cause analyses. The nurses in our study suggested several measures for the healthy functioning of the preanalytical phase and the prevention of medical errors, like centralizing the blood collection phase, avoiding the placement of patients with the same name in the same room, ensuring proper identity verification, increasing the number of healthcare professionals, providing specific training on the preanalytical phase, having experienced professionals manage the phase, forming specialized blood collection teams (including pediatric nurses), reducing laboratory waiting times, implementing dual checks for procedures, and avoiding hasty blood collection. The literature also emphasizes the importance of fostering understanding and cooperation among all relevant professional groups to enhance the preanalytical phase ( 15 ). It has also been emphasized that to prevent errors in the preanalytical phase, comprehensive guidelines and procedures need to be established, healthcare professionals should receive ongoing training, and a collaborative system should be developed to foster cooperation between laboratory personnel and clinical staff ( 22 ). In our study, nurses suggested several improvements for device manufacturers to enhance the preanalytical phase and reduce medical errors. These recommendations included developing devices that can display the vascular structure, designing equipment that requires fewer specimen volumes, creating smaller pediatric tubes, and producing machines that are more sensitive and capable of phasing small specimens. These recommendations are straightforward interventions that could be readily implemented. The responsibility for these improvements lies with device manufacturers, biomedical device developers, and institutional managers. The Effect of the Preanalytical Phase on Nurses' Well-being The study revealed that the preanalytical phase significantly impacted the well-being of nurses. Failures in this phase were often reflected to nurses through interactions with patients and their relatives. Nurses reported experiencing a range of negative emotions, including psychological pressure, helplessness, feelings of inadequacy, damage to professional dignity, loss of motivation, worthlessness, anxiety, guilt, and a lack of empathy during the preanalytical phase. A systematic review highlighted that nurses frequently felt anger, frustration, irritability, discomfort, guilt, regret, and self-blame when involved in patient safety incidents ( 23 ). Additionally, another study found that nurses experienced anxiety and frustration when disruptions occurred related to patients' test results ( 24 ). It has been observed that emotions are not universally experienced but are influenced by cultural contexts ( 25 ). Culture shapes not only the experience of emotions but also their expression ( 26 ). Intense emotions are often linked to heightened levels of arousal ( 25 ). Many factors, including the attitudes and behaviors of patients and their relatives, as well as workload, can influence the arousal levels of nurses. In our study, we identified a range of attitudinal behaviors exhibited by patients' relatives during the preanalytical phase, such as anger, questioning the professionalism of healthcare workers, expressing dissatisfaction or anger, complaining to management, engaging in verbal violence, making judgments, reacting emotionally, showing tolerance, expressing trust, questioning, and expressing discomfort. According to research, approximately one-third of nurses worldwide experience physical violence and bullying, one-third report injuries, about one-fourth face sexual harassment, and nearly two-thirds encounter non-physical violence ( 27 ). Such violent behaviors may arise when patients' relatives feel unsafe or when there is a perceived failure in healthcare delivery ( 28 ). To address these issues, it is crucial for nursing managers to educate nurses about the protocols for reporting incidents of violence, ensuring that nurses are aware of how to document such incidents, actively following up on reported cases, and taking proactive steps to prevent violence against nurses ( 29 ). A key finding in our study was that nurses consistently maintained a compassionate and professional approach by empathizing with the situations faced by patients and their relatives. This was evident in the behaviors they exhibited during the preanalytical phase, such as explaining procedures clearly, taking their time rather than rushing, expressing themselves effectively, exercising patience, and working to calm both patients and their families. The nurse-patient interaction is characterized as a professional and therapeutic relationship that enables nurses to assess, plan, and deliver healthcare aimed at meeting the essential needs of patients ( 30 ). Nurses often utilize communication strategies, including conversation, explanation, teaching, and providing information, to assist patients in coping with their situations and to ensure they feel comfortable and supported ( 31 ). In our study, we found that the coping mechanisms employed by nurses to maintain their well-being while providing comfort to patients included prioritizing professionalism, maintaining patience, striving to understand the perspectives of patients and their relatives, actively listening, coordinating with the laboratory in cases of specimen rejection, and finding practical solutions to ensure the timely delivery of blood specimens. These strategies not only help in managing the emotional demands of nursing but also enhance the overall patient care experience. Conclusion The evaluation of the study results in the preanalytical phase is presented in Fig. 1 . While the preanalytical phase includes ordering the specimen, preparing and barcoding the tubes, collecting the specimen from the patient, and sending it to the laboratory, multiple factors influence this phase. These include institutional factors, the patient profile, stakeholders involved, and the clinical setting. Each can impact the preanalytical phase, potentially leading to medical errors. Furthermore, negative incidents that occur during the preanalytical phase can significantly influence the attitudes and behaviors of patients and their relatives, which can in turn affect the well-being and emotional fatigue of nurses. Despite these challenges, nurses endeavor to maintain their well-being and provide emotional support to both patients and their families throughout the phase. Our study underscores the need for targeted strategies to enhance the preanalytical phase, improve nurse well-being, and reduce emotional exhaustion, thereby boosting overall care quality and operational efficiency. Implications for nursing practice and education The findings from this study underscore the critical role of nurses in the preanalytical phase, emphasizing the need for enhanced training and clear protocols to minimize medical errors. Nurses must be equipped with comprehensive knowledge of specimen handling procedures, patient identification protocols, and effective communication strategies to reduce errors in specimen collection and transport. Additionally, the emotional toll on nurses highlighted in the study calls for increased support systems, including counseling and stress management resources, to safeguard their well-being. Nursing education programs should incorporate practical training on the preanalytical phase, focusing on techniques for reducing errors and managing high-pressure situations. Moreover, fostering a collaborative environment between nurses, laboratory staff, and other healthcare professionals is essential to ensure the smooth functioning of the preanalytical phase, ultimately improving patient care and safety. Declarations Ethical Statement: Ethics committee approval numbered E-69268593-050.02.21421 was received by Avrasya University for the study. 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Surgical specimen management in the preanalytic phase: perioperative nursing implications. AORN journal. 2019;110(3):237-50. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical teacher. 2020;42(8):846-54. Ahmed SK. The pillars of trustworthiness in qualitative research. Journal of Medicine, Surgery, and Public Health. 2024;2:100051. Alshaghdali K, Alcantara TY, Rezgui R, Cruz CP, Alshammary MH, Almotairi YA, et al. Detecting preanalytical errors using quality indicators in a hematology laboratory. Quality Management in Healthcare. 2022;31(3):176-83. Carraro P, Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Clinical chemistry. 2007;53(7):1338-42. Getawa S, Aynalem M, Melku M, Adane T. Blood specimen rejection rate in clinical laboratory: A systematic review and meta-analysis. Practical Laboratory Medicine. 2023;33:e00303. Plebani M. Quality indicators to detect pre-analytical errors in laboratory testing. The Clinical Biochemist Reviews. 2012;33(3):85. Rickard JA, Rogers T-M, Westerman DA, Carolan C, Fox SB. Identification errors in medical research: Privacy at all costs? Contemporary Clinical Trials. 2023;130:107206. Cadamuro J, Baird G, Baumann G, Bolenius K, Cornes M, Ibarz M, et al. Preanalytical quality improvement–an interdisciplinary journey. Clinical Chemistry and Laboratory Medicine (CCLM). 2022;60(5):662-8. Malinowska-Lipień I, Micek A, Gabryś T, Kózka M, Gajda K, Gniadek A, et al. Impact of the work environment on patients’ safety as perceived by nurses in Poland—a cross-sectional study. International journal of environmental research and public health. 2021;18(22):12057. Buetow S, Davis R, Callaghan K, Dovey S. What attributes of patients affect their involvement in safety? A key opinion leaders’ perspective. BMJ open. 2013;3(8):e003104. Crilly J, Greenslade JH, Johnston A, Carlström E, Thom O, Abraham L, et al. Staff perceptions of the emergency department working environment: An international cross‐sectional survey. Emergency Medicine Australasia. 2019;31(6):1082-91. Fenta DA, Ali MM. Factors affecting quality of laboratory result during ordering, handling, and testing of the patient’s specimen at hawassa university college of medicine and health science comprehensive specialized hospital. Journal of Multidisciplinary Healthcare. 2020:809-21. Kim S-A, Kim E-M, Lee J-R. Causes of nurses' second victim distress: An objective analysis. Quality Management in Healthcare. 2022;31(3):122-9. Austin DM, Pauley G, Ferkins L. Establishing a Guide for Developing Organizational Support in Healthcare Following a Critical or Sentinel Event. Qualitative Health Research. 2022;32(11):1607-19. Nordin N, Ab Rahim SN, Omar WFAW, Zulkarnain S, Sinha S, Kumar S, et al. Preanalytical Errors in Clinical Laboratory Testing at a Glance: Source and Control Measures. Cureus. 2024;16(3). Sattar R, Lawton R, Janes G, Elshehaly M, Heyhoe J, Hague I, et al. A systematic review of workplace triggers of emotions in the healthcare environment, the emotions experienced, and the impact on patient safety. BMC Health Services Research. 2024;24(1):603. Litchfield I, Bentham L, Hill A, McManus RJ, Lilford R, Greenfield S. Routine failures in the process for blood testing and the communication of results to patients in primary care in the UK: a qualitative exploration of patient and provider perspectives. BMJ quality & safety. 2015;24(11):681-90. Lim N. Cultural differences in emotion: differences in emotional arousal level between the East and the West. Integrative medicine research. 2016;5(2):105-9. Schouten BC, Schinkel S. Emotions in primary care: are there cultural differences in the expression of cues and concerns? Patient education and counseling. 2015;98(11):1346-51. Spector PE, Zhou ZE, Che XX. Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. International journal of nursing studies. 2014;51(1):72-84. Havaei F, MacPhee M. The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of human factors framework. Nursing open. 2020;7(3):731-41. Babaei N, Rahmani A, Avazeh M, Mohajjelaghdam AR, Zamanzadeh V, Dadashzadeh A. Determine and compare the viewpoints of nurses, patients and their relatives to workplace violence against nurses. Journal of Nursing Management. 2018;26(5):563-70. Vujanić J, Mikšić Š, Barać I, Včev A, Lovrić R, editors. Patients’ and Nurses’ Perceptions of Importance of Caring Nurse–Patient Interactions: Do They Differ? Healthcare; 2022: MDPI. Thomas D, Newcomb P, Fusco P. Perception of caring among patients and nurses. Journal of patient experience. 2019;6(3):194-200. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 29 Jan, 2025 Editor assigned by journal 27 Jan, 2025 Submission checks completed at journal 27 Jan, 2025 First submitted to journal 18 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5856592","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":407725858,"identity":"b74399e8-15e4-4106-b5f4-5e7b1b3f3f59","order_by":0,"name":"Yasemin GÜNER","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYNACAwYGCQbmxsdgDjNzA7FaGJuNwSxmRmK0MIC1tEmDtTAQ0GJw/PjDRzcK7jBIzkhsqy6o+BPN3w7U8qNiG24tZ3KMjXMMnjFISyS23Z5xxiB3xmHGBsaeM7dxazmQwyadY3C4fh5IC2+bQW4DUAszYxseLeefP/8N1MIgB9RSDNIyn6CWGwlmzCAtIIcxg7RsIKRF8sYbY5DDGCR7HjZL85wxzt0I1HIQn1/4zqc//Jzz5zCDxPHkg595KuRy550/fPDBjwrcWhQOYBPFKggD8g34ZEfBKBgFo2AUgAAAYDFZkeNhR5UAAAAASUVORK5CYII=","orcid":"","institution":"Karadeniz Technical University","correspondingAuthor":true,"prefix":"","firstName":"Yasemin","middleName":"","lastName":"GÜNER","suffix":""},{"id":407725859,"identity":"9fb834fd-10c2-495c-8555-147f7bfdccac","order_by":1,"name":"Elif KILIÇ GÜNER","email":"","orcid":"","institution":"Karadeniz Technical University","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"KILIÇ","lastName":"GÜNER","suffix":""},{"id":407725860,"identity":"d01eb72c-895d-4ee8-adb4-875ec426d546","order_by":2,"name":"Melek ÜÇÜNCÜOĞLU","email":"","orcid":"","institution":"Karadeniz Technical University","correspondingAuthor":false,"prefix":"","firstName":"Melek","middleName":"","lastName":"ÜÇÜNCÜOĞLU","suffix":""},{"id":407725861,"identity":"15460e52-131a-4620-9e9a-b8629eb5308a","order_by":3,"name":"Harun YÜKSEL","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Harun","middleName":"","lastName":"YÜKSEL","suffix":""}],"badges":[],"createdAt":"2025-01-18 18:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5856592/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5856592/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03426-w","type":"published","date":"2025-07-01T15:57:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75000937,"identity":"e3c0fef1-23fc-44a3-87ff-7544a82b78d7","added_by":"auto","created_at":"2025-01-29 09:45:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":181517,"visible":true,"origin":"","legend":"\u003cp\u003eEvaluation of the preanalytical phase in the context of study results\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5856592/v1/70e6e7c6eea7be3dd6d16afd.png"},{"id":86179029,"identity":"e12c2f95-950e-4f69-94d0-64f4ffcf2137","added_by":"auto","created_at":"2025-07-07 16:14:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1266718,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5856592/v1/c423c57a-2206-4fd8-a7e8-eaad8a6fbdb3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Specimen Rejection Rates in the Preanalytical Phase and Nurses' Experiences: A Mixed Design Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eClinical laboratories play a vital role in ensuring patient safety (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The American College of Pathology highlighted the importance of laboratory safety as early as 1946 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Laboratory tests provide essential information that influences diagnostic and therapeutic decisions, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) with an estimated 60\u0026ndash;70% of these decisions relying on test results (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). As a result, laboratory tests are an indispensable part of modern clinical diagnosis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The laboratory testing phase consists of three main phases: pre-analytical, analytical, and post-analytical. The pre-analytical phase is the most error-prone, accounting for 70% of all laboratory errors. This phase includes ordering the correct test for the patient, collecting the specimen, transporting it, and preparing it for analysis(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Errors in the pre-analytical phase can harm the institution's reputation, erode trust in healthcare services, increase overall costs for the laboratory and hospital, and negatively impact the institution's financial situation. Furthermore, errors in the pre-analytical phase increase the overall costs for the laboratory and the hospital, thereby negatively affecting the institution's financial capacity. Improving laboratory processes can thus contribute positively to disease prevention, diagnosis, treatment, clinical monitoring, and the reduction of operating costs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Nurses were chosen for these interviews because they are primarily responsible for the sampling during the pre-analytical phase and play a key role in communicating between patients and the healthcare team (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study aims to examine the rejection rates of specimens during the preanalytical phase over the past year and to reveal the reasons behind sample specimen and determine the experiences of nurses through individual, in-depth interviews with nurses from relevant units.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eDesign\u003c/strong\u003e \u003cp\u003eThis mixed-methods study was designed to combine both quantitative and qualitative research approaches, utilizing retrospective data analysis and individual in-depth interviews. The research was conducted at a tertiary university hospital with a capacity of 832 beds, employing approximately 800 nurses and 900 physicians. The hospital also provides education, research, and health services, making it a comprehensive setting for the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eParticipants and setting\u003c/b\u003e: The study was carried out in two stages. In the first stage, data on specimen rejections from the microbiology and biochemistry laboratories were collected over a one-year period (from October 1, 2022, to September 30, 2023). The specimens were evaluated based on the laboratory reports submitted to the indicator management system, which adheres to the Ministry of Health Quality and Performance Directive for Laboratory Safety. The rejected specimens were identified using the Ministry of Health Laboratory Errors Classification System-Code Table. Specimen rejection data were collected from various units, including outpatient blood collection units (adult and pediatric), emergency departments, intensive care units, and inpatient wards (pediatric and adult). The units were categorized into four groups: internal units, surgical units, specialized units, and pediatric units.\u003c/p\u003e \u003cp\u003eIn the second stage of the study, individual in-depth interviews were conducted with nurses from the identified units with the highest rates of specimen rejections. The study involved 16 nurses who volunteered to participate.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Collection\u003c/strong\u003e \u003cp\u003eFor the data collection in the second stage, a purposive sampling method was employed. Individual in-depth interviews were carried out with the 16 nurses working in the units with the highest specimen rejection rates. The interviews were conducted until data saturation was reached, meaning that no new information was obtained from subsequent interviews. Each interview lasted approximately 45 minutes and was conducted face-to-face using semi-structured questions. The interviews were audio recorded for later transcription and analysis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Analysis\u003c/strong\u003e \u003cp\u003eQuantitative data were analyzed using descriptive statistics, with qualitative variables presented as frequencies.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e For qualitative data, the audio recordings from the individual in-depth interviews, obtained with voluntary consent, were transcribed using the 'Transcriber' application. The resulting texts were verified by the researchers (XX) who conducted the interviews, ensuring accuracy by cross-checking the transcripts against the original audio recordings. Participants' identities were protected by assigning each a code name in the transcriptions. Thematic analysis was employed to analyze the qualitative data (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The researchers independently reviewed the transcripts, considering the research questions and sub-questions, to generate initial codes. They convened in joint meetings to reconcile and agree upon these initial codes. Following this agreement, the researchers collaboratively categorized and thematized the codes, finalizing the analysis of the qualitative data.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTrustworthiness\u003c/strong\u003e \u003cp\u003eThe study utilized several strategies to ensure trustworthiness. Validity was enhanced by continuing the interviews until data saturation was reached, and by combining both quantitative and qualitative data to validate the findings. Transferability was ensured by providing detailed descriptions of the setting and participants, allowing the results to be applicable in similar contexts. Dependability was ensured by documenting the research process clearly and applying consistent data collection methods. Finally, confirmability was achieved by maintaining an audit trail and using peer debriefing to minimize researcher bias and ensure objectivity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These strategies contributed to the overall trustworthiness of the study\u0026rsquo;s findings.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical issues\u003c/strong\u003e \u003cp\u003e Ethics committee approval numbered E-69268593-050.02.21421 was gave for by \u0026ldquo;Ethical committee of scientific research of XXX\u0026rdquo; the study.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative data\u003c/h2\u003e \u003cp\u003eAccording to the study results, 14290 samples were rejected in the biochemistry laboratory and 4220 specimens were rejected in the microbiology laboratory in a one-year period (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). When Specimen rejections were examined in terms of units, the highest number of Specimen rejections in the biochemistry and microbiology laboratories occurred in internal units (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCauses for specimen rejection by units in the microbiology laboratory within one year\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurgical Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialized Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePediatric Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect Test Order (L01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing/Incorrect Information in the Test Order (L02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnregistered sample (L04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect Registration (L05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSampling from the Wrong Patient (L06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMisidentified Specimen (L07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLost Specimen (L08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecollected Specimen (L09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect Specimen Container/Tube (L10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpty Specimen Container/Tube (No Specimen Inside) (L11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancellation of Registration Due to Failure to Collect the Specimen from the Patient (L14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproperly Collected Specimen (L15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient Specimen (L16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1460\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemolyzed Specimen (L17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1299\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClotted Specimen (L18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1299\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLipemic Specimen (L19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSampling time not recorded (L22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecimen not delivered to the laboratory (L23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInappropriate transfer conditions (L24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExceeding the specified maximum specimen transfer time (L25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixing of specimens (L26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcceptance of rejected specimen (L27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproperly stored specimen (L29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-arrival of requested material/kit (L32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevice pipetting error (L40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFailure to comply with test run procedures (L42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect technical approval (L53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResult not delivered on time (L57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1342\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCauses for specimen rejection by units in the biochemistry laboratory within one year\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurgical Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialized Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePediatric Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect Test Orders (L1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing/Incorrect Information in the Test Order (L02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect Registration (L05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSampling from the Wrong Patient (L06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMisidentified Specimen (L07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLost Specimen (L08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecollected Specimen (L09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect Specimen Container/Tube (L10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpty Specimen Container/Tube (No Specimen Inside) (L11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancellation of Registration Due to Failure to Collect the Specimen from the Patient (L14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproperly Collected Specimen (L15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient Specimen (L16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e5571\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemolyzed Specimen (L17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e783\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClotted Specimen (L18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e5715\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLipemic Specimen (L19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecimen not delivered to the laboratory (L23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInappropriate transfer conditions (L24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExceeding the specified maximum specimen transfer time (L25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixing of specimens (L26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcceptance of rejected specimen (L27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAutomation malfunction (L28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproperly stored specimen (L29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-arrival of requested material/kit (L32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInappropriate transfer conditions (L34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevice pipetting error (L40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient homogenization of the specimen (L41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResult not delivered on time (L57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4687\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most common Specimen rejection reasons in the biochemistry laboratory were insufficient Specimen (5571), hemolyzed specimen (783), coagulated specimen (5715) and (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the microbiology laboratory, the most common sample rejection reasons, similar to the biochemistry laboratory, were insufficient specimen (1460), hemolyzed specimen (1299) and coagulated specimen (1299) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQualitative data\u003c/h3\u003e\n\u003cp\u003eAs a result of the qualitative data analysis from our study, three main themes emerged: The preanalytical phase, the causes of medical errors within this phase, and the impact of the preanalytical phase on the well-being of nurses (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuotations related to the themes that emerged in our study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTheme 1: The Functioning of the Preanalytical Phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSteps Applied in the Preanalytical Phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The blood collection phase starts when the doctor places the order. Then, the tubes are prepared, barcoded, and the blood is drawn (N1).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We can take blood from patients in the clinic, during their initial admission, or while preparing for surgery (N5).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses' Reasons for Specimen Rejection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;... Rejection can happen if blood tubes are underfilled or overfilled. This causes problems for both the patient and us... (N4)\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Most of the time, we find out about a specimen rejection from a notification on the computer screen, or they call us when there's a critical value (N7).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;... The system reflects when specimens are rejected. Sometimes there's clotting because the blood wasn't collected properly, and sometimes we can't fill the tube enough, especially in difficult cases like pediatric patients, and it gets reported as an insufficient specimen (N8).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When following up on patients' results, you notice a huge difference between the blood test results from one day to the next. Of course, this doesn't match the patient's clinical condition... In such cases, we recollect the specimen and find out that the original result wasn't actually from that patient... (N16).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTheme 2: Causes of Medical Errors in the Preanalytical Phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStakeholder-Related Causes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Patients are often seen as tasks to be completed because we are understaffed and always rushing to get things done. This leaves us open to making mistakes (N3).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;In the morning, all the barcoded blood tubes for the patients are left on the treatment cart and collected one by one. There were two patients with the same name. I picked up the tube and took blood from a patient. Later, my colleague started looking for a blood tube, and we realized I had taken blood from the wrong patient. I immediately disposed of the incorrect tubes and took the correct specimens from the right patient... (N9).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When babies are monitored in incubators, the identifier is attached to the incubator because the skin on their arms is delicate. This can cause problems (N10).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We enter the blood specimens into the system at night to avoid difficulties in the morning. The fatigue from night shifts makes us prone to errors (N11).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Experience is crucial in the blood collection phase. For example, new colleagues sometimes can't manage the phase (N14).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical Setting-Related Causes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I would like to collect blood in one go, but there are so many patients, so we need to hurry. The environment is stressful, and if we don't get it right the first time, the patient\u0026rsquo;s relatives complain, and it causes stress... (N6).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Think about it; we collect blood from over five hundred patients. It\u0026rsquo;s crowded, and sometimes patients can\u0026rsquo;t hear you calling them because of the noise... (N12).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient Profile-Related Causes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Patients are often absentminded, probably because the hospital environment exhausts them. They come with the wrong tube; you call out the name written on it; they nod, but then you find out they\u0026rsquo;re the wrong patient... (N2).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Patients' existing medical conditions can affect the blood collection phase, for example, patients with clotting disorders or those undergoing cancer treatment... (N13).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s harder to draw blood from children than adults due to their vein structure, their behavior, and pressure from their families... (N15).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstitution-Related Causes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When we have issues with patients' relatives and the institution doesn\u0026rsquo;t support us, it makes us feel undervalued. All we want is for them to acknowledge that we are human too... (N6).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Unfortunately, our workload is too heavy. Sometimes, we send blood specimens via courier, but occasionally the specimens sit there because the courier is away (transporting a patient elsewhere). I rush to the lab to deliver the specimens so the patient isn't affected (N7).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We learned the blood collection phase during our undergraduate studies, then from more experienced colleagues. We haven't received specific training on what to pay attention to (N11).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTheme 3: The Effect of the Preanalytical Phase on Nurses' Well-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses' Emotional Fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I feel sad and worthless when I do not receive support from my institution in the face of patient complaints. We expect to be understood a little bit. I think we have a demanding profession (N10).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Pediatric patients often involve handling sensitive parents. Blood collection in children can be challenging, and I sometimes need to squeeze the child's hand to encourage blood flow from the back of the hand. The situation is often stressful, as children may cry and parents might express impatience, asking if the procedure is done yet, which causes pressure (N12).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo; Well, we try to explain and make them understand. It's a stressful phase, it's a difficult phase. Working there requires patience (N16).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient and Family Attitudes Toward Nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes we have trouble collecting blood, and patients can get angry and react even more when we have to try again. In the following days, they often remind us that we couldn't do it last time (N1).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Most of the babies we see are premature, and their mothers understandably get upset when they see bruises on their babies' hands or arms after procedures like drawing blood (N5).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;...Very rarely do patients choose to be understanding. Often, they leave saying, 'I will complain about you.' I understand they're upset, but we're human beings too (N13).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProviding Emotional Support to Patients and Families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I don't rush when approaching the patient; I ask questions and always try to create a more relaxed atmosphere (N8).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When we need to draw blood again, patients and their relatives often react by asking why we need to collect more blood, especially if we've just done it. In these situations, I try to explain the reasons and calm them down (N9).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses' efforts to maintain their well-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We nurses are always the ones solving problems, whether it's ensuring blood specimens are delivered or communicating with the lab if there's an issue... (N3).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It requires professionalism and understanding the patient. You have to understand the child as well, and that's always the perspective you approach it from (N14).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 1: The Functioning of the Preanalytical Phase\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSteps Applied in the Preanalytical Phase: The nurses described the steps involved in the preanalytical phase as follows: Initially, a blood order is made through the computer system. Following this, the necessary tubes or containers for sampling are prepared. The tubes or containers are then barcoded, either manually or by using a device. Blood is then collected from the patient, and the barcodes are scanned. Finally, the specimens are sent to the laboratory, typically via a pneumatic system or through email notification.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNurses' Reasons for Specimen Rejection:Nurses mentioned several reasons for rejecting specimens: clotted specimens, incorrect barcoding, collecting blood from the wrong patient, lost specimens, insufficient specimen volume, incorrect registration in the system, barcode stickers not sticking properly (due to poor-quality materials), and hemolysis.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHealthcare Professionals\u003cem\u003e'\u003c/em\u003e Noticing Specimen Rejection: The nurses noticed specimen rejections when the patient's blood results didn't match their clinical condition when the lab notified them, when they suspected the results, when there was a delay in getting the results, or when there was an alert about critical values.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 2: Causes of Medical Errors in the Preanalytical Phase\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStakeholder-Related Causes:In our study, several causes related to healthcare professionals were identified as causes of medical errors. These include incorrect patient identification, unclear responsibilities, lack of experience, improper handling of administrative phases, incorrect techniques in drawing blood, rushing the blood collection phase, delays in blood collection, delays in delivering blood to the laboratory, communication breakdowns between laboratories and clinics, lack of empathy, and entering blood specimens into the system during night shifts.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eClinical Setting-Related Causes: In our study, several factors related to the clinical setting were identified as contributing to medical errors. These include a great number of patients, rapid patient turnover, a noisy environment, and a generally stressful work setting.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatient Profile-Related Causes:Patient-related factors contributing to errors were identified as cognitive impairment, the patient's age group, existing medical conditions, and special needs.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eInstitution-Related Causes:Institutional factors identified in our study include unclear job descriptions, excessive workload, lack of in-service training in the preanalytical phase, lack of institutional support, and insufficient time allocated to patients.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRecommendations for the Healthy Operation of the Preanalytical Phase and Prevention of Medical Errors\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRecommendations for Institutions: The nurses in our study provided several recommendations to institutions for ensuring the smooth operation of the preanalytical phase and preventing medical errors. They recommended streamlining the blood collection phase by using a single source of data, to avoid placing patients with the same name in the same room to prevent identity confusion, to verify patient identity along with the importance of informing staff about the patient's name and surname during blood orders, to verify patient identity information during the secretarial phase, to increase the number of healthcare professionals, provide training specific to the preanalytical phase, and involve experienced healthcare professionals, to establish a dedicated blood collection team (including a pediatric nurse), to reduce waiting times in the laboratory, to have two people check the blood and avoid rushing the blood draw.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRecommendations for Device Manufacturers: Nurses also offered suggestions to device manufacturers to support the preanalytical phase and reduce medical errors. They recommended developing devices that can easily visualize vascular structures, creating devices that require fewer specimen quantities, making pediatric tubes smaller, and designing pediatric machines that are more sensitive and capable of working with minimal specimen amounts.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: The Effect of the Preanalytical Phase on Nurses' Well-being\u003c/h2\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eNurses' Emotional Fatigue: The study revealed that nurses experience significant emotional strain during the preanalytical phase. They reported feeling psychological pressure, helplessness, negative self-perception, damage to their professional dignity, a loss of motivation, a sense of worthlessness, anxiety, remorse, and a deep sense of empathy for their patients.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatient and Family Attitudes Toward Nurses: The study found that patients and their families often exhibit various attitudes toward nurses during the preanalytical phase like anger, questioning the nurse's professionalism, frustration, filing complaints with management, verbal abuse, judgment, reacting negatively, being understanding, trusting, questioning, and expressing discomfort.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Providing Emotional Support to Patients and Families: In our study, it was observed that during the preanalytical phase, nurses tended to explain the situation to patients and their relatives, avoid rushing, try to express themselves clearly, be patient, wait for patients and their relatives to calm down, and work to soothe the patients.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNurses' efforts to maintain their well-being:In our study, nurses employed various coping mechanisms to maintain their well-being, like consciously reminding themselves to be patient, trying to understand patients and their families, striving to uphold professionalism, listening to patients, communicating with the laboratory in case of specimen rejection, and finding solutions to ensure the timely delivery of specimens to the lab.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study aims to examine the rejection rates of specimens during the preanalytical phase over the past year and to reveal the reasons behind sample specimen and determine the experiences of nurses through individual, in-depth interviews with nurses from relevant units.\u003c/p\u003e\n\u003ch3\u003eFunctioning of the Preanalytical Phase\u003c/h3\u003e\n\u003cp\u003eThe nurses detailed the steps involved in the preanalytical phase, highlighted the reasons for specimen rejection, and described how they noticed issues with the specimens.\u003c/p\u003e \u003cp\u003eOur findings indicate that the most common causes for specimen rejection, as reported by the hospital's indicator management system, were insufficient, hemolyzed and clotted specimens. In addition, the highest rate of specimen rejection in the biochemistry laboratory and microbiology laboratory were in internal unit. Nurses in our study cited clotted specimens, incorrect barcoding, blood collection from the wrong patient, specimen loss, insufficient specimen volume, data registration omissions in the system, non-adhering barcodes (due to poor quality materials), and hemolysis as the primary causes of specimen rejection. Similar findings have been reported in other studies, where common causes for specimen rejection include incomplete specimen and/or test orders, incorrect or incomplete patient identification, contamination from infusion routes, hemolyzed, clotted, and insufficient specimens, inappropriate containers, incorrect blood/anticoagulant ratios, and improper transport and storage conditions (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, the nurses mentioned that they often realized a specimen had been rejected when there was a discrepancy between the patient\u0026rsquo;s blood test results and their clinical presentation, or when the laboratory notified them of an issue. In our study, it was observed that most errors are detected only after the specimen reaches the laboratory. While these errors are identified before they directly impact patient care, they pose a significant risk of leading to misdiagnosis and incorrect treatment, emphasizing the need for precautionary measures.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCauses of Medical Errors in the Preanalytical Phase\u003c/h2\u003e \u003cp\u003eWe identified several factors contributing to medical errors in the preanalytical phase, including those related to stakeholders, the clinical setting, patient profiles, and administrative factors. The preanalytical phase, a critical component of laboratory diagnostics, encompasses patient preparation, specimen collection, transport, preparation, and storage (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). According to our findings, numerous preventable factors influence the preanalytical phase, consistent with relevant literature.\u003c/p\u003e \u003cp\u003eThe study highlighted several causes of medical errors linked to healthcare professionals, such as improper patient identification, unclear responsibilities, lack of experience, improper management of the secretarial phase, incorrect blood collection techniques, haste in blood collection, prolonged collection procedures, delays in transporting blood to the laboratory, communication breakdowns between the laboratory and clinical staff, and the practice of ordering blood work during night shifts. One study underscored the importance of effective patient identification in the preanalytical phase as a critical point where errors can occur (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Another study emphasized the challenges related to the transfer of specimens post-collection, indicating that mishandling during this phase can lead to significant diagnostic inaccuracies (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Maintaining effective dynamics and strengthening communication among healthcare professionals is crucial in preventing medical errors. Enhancing the technical and non-technical skills of healthcare workers is essential for improving the preanalytical phase.\u003c/p\u003e \u003cp\u003eIn our study, factors related to the clinical setting contributing to medical errors included a high patient load and turnover, noise, and a stressful working environment. Previous research has shown a positive relationship between sufficient staffing levels, effective cooperation between nurses and physicians, management support, and patient safety (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Another study identified intense workload and insufficient professional skills as the most significant stressors among healthcare professionals (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Improving the working conditions for nurses, therefore, could significantly enhance patient safety.\u003c/p\u003e \u003cp\u003eAdditionally, patient-related factors identified in our study, such as perception disorders, age groups, and existing medical conditions, were found to impact the preanalytical phase. Nurses need specialized training in managing care for individuals with special needs. The literature also emphasizes that patients and their families play a critical role in ensuring patient safety (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, institutional factors contributing to medical errors included unclear job descriptions, intense workloads, lack of in-service training in the preanalytical phase, insufficient institutional support, and inadequate time allocated to patient care. A study by Assegu Fenta et al. highlighted poor management support and heavy workloads as key factors affecting the preanalytical phase (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Another study demonstrated that institutional support can significantly reduce medical errors (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The literature offers various guidelines and policy recommendations to provide such support (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Institutions bear a significant responsibility in improving the preanalytical phase, including the human factors involved, assessing the quality of training programs, and conducting root cause analyses.\u003c/p\u003e \u003cp\u003eThe nurses in our study suggested several measures for the healthy functioning of the preanalytical phase and the prevention of medical errors, like centralizing the blood collection phase, avoiding the placement of patients with the same name in the same room, ensuring proper identity verification, increasing the number of healthcare professionals, providing specific training on the preanalytical phase, having experienced professionals manage the phase, forming specialized blood collection teams (including pediatric nurses), reducing laboratory waiting times, implementing dual checks for procedures, and avoiding hasty blood collection. The literature also emphasizes the importance of fostering understanding and cooperation among all relevant professional groups to enhance the preanalytical phase (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). It has also been emphasized that to prevent errors in the preanalytical phase, comprehensive guidelines and procedures need to be established, healthcare professionals should receive ongoing training, and a collaborative system should be developed to foster cooperation between laboratory personnel and clinical staff (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, nurses suggested several improvements for device manufacturers to enhance the preanalytical phase and reduce medical errors. These recommendations included developing devices that can display the vascular structure, designing equipment that requires fewer specimen volumes, creating smaller pediatric tubes, and producing machines that are more sensitive and capable of phasing small specimens. These recommendations are straightforward interventions that could be readily implemented. The responsibility for these improvements lies with device manufacturers, biomedical device developers, and institutional managers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe Effect of the Preanalytical Phase on Nurses' Well-being\u003c/h2\u003e \u003cp\u003eThe study revealed that the preanalytical phase significantly impacted the well-being of nurses. Failures in this phase were often reflected to nurses through interactions with patients and their relatives. Nurses reported experiencing a range of negative emotions, including psychological pressure, helplessness, feelings of inadequacy, damage to professional dignity, loss of motivation, worthlessness, anxiety, guilt, and a lack of empathy during the preanalytical phase. A systematic review highlighted that nurses frequently felt anger, frustration, irritability, discomfort, guilt, regret, and self-blame when involved in patient safety incidents (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Additionally, another study found that nurses experienced anxiety and frustration when disruptions occurred related to patients' test results (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). It has been observed that emotions are not universally experienced but are influenced by cultural contexts (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Culture shapes not only the experience of emotions but also their expression (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Intense emotions are often linked to heightened levels of arousal (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Many factors, including the attitudes and behaviors of patients and their relatives, as well as workload, can influence the arousal levels of nurses.\u003c/p\u003e \u003cp\u003e In our study, we identified a range of attitudinal behaviors exhibited by patients' relatives during the preanalytical phase, such as anger, questioning the professionalism of healthcare workers, expressing dissatisfaction or anger, complaining to management, engaging in verbal violence, making judgments, reacting emotionally, showing tolerance, expressing trust, questioning, and expressing discomfort. According to research, approximately one-third of nurses worldwide experience physical violence and bullying, one-third report injuries, about one-fourth face sexual harassment, and nearly two-thirds encounter non-physical violence (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Such violent behaviors may arise when patients' relatives feel unsafe or when there is a perceived failure in healthcare delivery (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). To address these issues, it is crucial for nursing managers to educate nurses about the protocols for reporting incidents of violence, ensuring that nurses are aware of how to document such incidents, actively following up on reported cases, and taking proactive steps to prevent violence against nurses (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA key finding in our study was that nurses consistently maintained a compassionate and professional approach by empathizing with the situations faced by patients and their relatives. This was evident in the behaviors they exhibited during the preanalytical phase, such as explaining procedures clearly, taking their time rather than rushing, expressing themselves effectively, exercising patience, and working to calm both patients and their families. The nurse-patient interaction is characterized as a professional and therapeutic relationship that enables nurses to assess, plan, and deliver healthcare aimed at meeting the essential needs of patients (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Nurses often utilize communication strategies, including conversation, explanation, teaching, and providing information, to assist patients in coping with their situations and to ensure they feel comfortable and supported (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In our study, we found that the coping mechanisms employed by nurses to maintain their well-being while providing comfort to patients included prioritizing professionalism, maintaining patience, striving to understand the perspectives of patients and their relatives, actively listening, coordinating with the laboratory in cases of specimen rejection, and finding practical solutions to ensure the timely delivery of blood specimens. These strategies not only help in managing the emotional demands of nursing but also enhance the overall patient care experience.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe evaluation of the study results in the preanalytical phase is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. While the preanalytical phase includes ordering the specimen, preparing and barcoding the tubes, collecting the specimen from the patient, and sending it to the laboratory, multiple factors influence this phase. These include institutional factors, the patient profile, stakeholders involved, and the clinical setting. Each can impact the preanalytical phase, potentially leading to medical errors. Furthermore, negative incidents that occur during the preanalytical phase can significantly influence the attitudes and behaviors of patients and their relatives, which can in turn affect the well-being and emotional fatigue of nurses. Despite these challenges, nurses endeavor to maintain their well-being and provide emotional support to both patients and their families throughout the phase.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOur study underscores the need for targeted strategies to enhance the preanalytical phase, improve nurse well-being, and reduce emotional exhaustion, thereby boosting overall care quality and operational efficiency.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eImplications for nursing practice and education\u003c/h2\u003e \u003cp\u003eThe findings from this study underscore the critical role of nurses in the preanalytical phase, emphasizing the need for enhanced training and clear protocols to minimize medical errors. Nurses must be equipped with comprehensive knowledge of specimen handling procedures, patient identification protocols, and effective communication strategies to reduce errors in specimen collection and transport. Additionally, the emotional toll on nurses highlighted in the study calls for increased support systems, including counseling and stress management resources, to safeguard their well-being. Nursing education programs should incorporate practical training on the preanalytical phase, focusing on techniques for reducing errors and managing high-pressure situations. Moreover, fostering a collaborative environment between nurses, laboratory staff, and other healthcare professionals is essential to ensure the smooth functioning of the preanalytical phase, ultimately improving patient care and safety.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Statement:\u003c/strong\u003e\u0026nbsp; Ethics committee approval numbered E-69268593-050.02.21421 was received by Avrasya University for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003eNo financial support was received.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAykal G, Yeğin A, Aydın \u0026Ouml;, Yılmaz N, Ellidağ HY. 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Journal of patient experience. 2019;6(3):194-200.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"error prevention, preanalytical phase, patient safety, nursing, medical error","lastPublishedDoi":"10.21203/rs.3.rs-5856592/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5856592/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAim of the study was to examine the rejection rates of specimens in the preanalytical phase and to determine the experiences of nurses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA mixed design was used in the study, combining retrospective data analysis and individual in-depth interviews. First, data on specimens rejection reported by microbiology and biochemistry laboratories were collected for one year. Then, individual in-depth interviews were conducted with nurses working in the clinics with the highest specimens rejection rates.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAs a result of the study, three main themes were determined: the functioning of the preanalytical phase, the causes of medical errors in the preanalytical phase, and the impact of the preanalytical phase on the well-being of nurses.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese results, institutional factors, patient profiles, stakeholders involved in the phase, and the clinical environment all affect the preanalytical phase, potentially leading to medical errors; this phase also affects the attitudes and behaviors of patients and their relatives, and the well-being of nurses, causing emotional fatigue. Despite these difficulties, nurses strive to protect their well-being and provide emotional support to patients and their families. Based on the findings of our study, there is a need for strategies focused on ensuring the well-being of nurses, and reducing emotional fatigue.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e \u003cp\u003eNot applicaple.\u003c/p\u003e","manuscriptTitle":"Evaluation of Specimen Rejection Rates in the Preanalytical Phase and Nurses' Experiences: A Mixed Design Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-29 09:44:56","doi":"10.21203/rs.3.rs-5856592/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-29T23:19:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-27T14:24:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-27T14:21:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-01-18T18:49:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54ef4eef-47c3-48a2-b983-9abf338c1d67","owner":[],"postedDate":"January 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:03:30+00:00","versionOfRecord":{"articleIdentity":"rs-5856592","link":"https://doi.org/10.1186/s12912-025-03426-w","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-07-01 15:57:47","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-01-29 09:44:56","video":"","vorDoi":"10.1186/s12912-025-03426-w","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03426-w","workflowStages":[]},"version":"v1","identity":"rs-5856592","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5856592","identity":"rs-5856592","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}