Trend analysis of laboratory specimen rejection rates at Debre Markos comprehensive specialized hospital, North West Ethiopia: Four-years document review

Trend analysis of laboratory specimen rejection rates at Debre Markos comprehensive specialized hospital, North West Ethiopia: Four-years document review | 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 Trend analysis of laboratory specimen rejection rates at Debre Markos comprehensive specialized hospital, North West Ethiopia: Four-years document review Bewket Mesganaw, Ketema Misganaw, Mekuriaw Belayneh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6361690/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Clinical laboratory errors can be classified into pre-analytical, analytical, and post-analytical phases. The majority of laboratory errors originate from the manually intensive activities of the pre-analytical phase, primarily those related to the collection, handling, transportation, preparation, and storage of diagnostic specimens. Objective: The aim of this study was to assess the trend of laboratory specimen rejection rates at a specialized hospital in Ethiopia. Method : A four-year document review was conducted at Debre Markos Comprehensive Specialized Hospital Laboratory from January 2020 to December 2023 to assess trends in the laboratory specimen rejection rate. Records of referred specimens for laboratory tests such as viral load, CD4 count, GeneXpert, and early infant diagnosis were included and reviewed. Finally, statistical analysis was performed using SPSS version 22.0 software. Results: Of the total 35,673 specimens submitted to the Debre Markos Comprehensive Specialized Laboratory from January 2020 to December 2023, 560 were rejected, resulting in an overall laboratory specimen rejection rate of 1.57%. The annual rejection rates were 2.30%, 1.59%, 1.42%, and 1.26%, respectively, from 2020 to 2023. Conclusion: Although the trends of laboratory specimen rejection rates among referred specimens was gradually improved from 2020 to 2023, still needs more interventions until it meets to the standard specimen rejection rate of 0.3%. specimen rejection rate clinical laboratory errors laboratory quality management system Figures Figure 1 Background Clinical laboratories are an essential and fundamental part of all health systems, aiming to improve health outcomes. To ensure effective treatment for patients, establishing and maintaining a laboratory quality management system is mandatory ( 1 , 2 ). Laboratory errors, which are defects throughout the entire laboratory testing process, can negatively affect the clinical decision-making process. Several studies have shown that the majority of these errors originate from the manually intensive activities of the pre-analytical phase, mainly related to the collection, handling, transportation, preparation, and storage of diagnostic specimens ( 3 , 4 , 5 ). Improper sample collection may lead to poor outcomes, such as incorrect diagnosis, inappropriate treatment, and even death. Problems such as incorrect patient or sample identification, sample instability due to transport delays or inappropriate containers, insufficient sample volume, and clotted or hemolyzed samples are some examples of criteria for rejection ( 1 , 6 ). Specimen rejection may have clinically significant consequences for patients. Patients whose specimens are rejected are mostly subjected to repeated specimen collection, resulting inconvenience, and the discomfort of repeated phlebotomy ( 7 ). In the implementation of specimen referral system, specimens are collected from any health facility and transported via a suitable courier system to referral laboratories where the testing service is available ( 8 ). Debre Markos Comprehensive Specialized Hospital Laboratory serves as one of the referral laboratories to which surrounding health facilities send specimens for testing, especially for viral load, GeneXpert for tuberculosis (TB), Early Infant Diagnosis (EID) for HIV, and CD4 testing. However, no study has been conducted in the area to gather detailed information about the trends in laboratory specimen rejection. Therefore, the aim of this study was to assess the trends of laboratory specimen rejection among referred specimens at Debre Markos Comprehensive Specialized Hospital Laboratory. Methods Study design, setting and participants A four-years document review was conducted from January 2020 to December 2023 at Debre Markos comprehensive specialized hospital. Under Debre Markos comprehensive specialized hospital laboratory 56 health facilities were linked for referral network. These were 9 district hospitals, 46 health centers and 1 private clinic. All referred specimens were included as study participants. Data source and procedures Records of laboratory specimens at Debre Markos comprehensive specialized hospital laboratory from 2020 to 2023 were included and reviewed. Data extraction checklist was prepared and used to collect information regarding specimen rejection from the specimen receiving and rejection logbook. After training and brief orientation for data collectors, data was collected using the prepared extraction tool. Data variables Dependent variables: specimen rejection rate Independent variables: specimen type, requested laboratory test type and reasons for rejections which includes hemolysis, inadequate volume, clotted specimen, unlabeled specimen, samples with no request paper, delayed time, not maintained cold chain, Contaminated specimen, inappropriate specimen container Statistical analyses The collected data was transferred to Statistical Package for Social Sciences (SPSS) 22.0 software. The number of rejected specimens per total referred specimens submitted was calculated to estimate the overall laboratory specimen rejection rate. Other descriptive statistics was also done to show the reasons and problems related to specimen rejection among referred laboratory specimens. Results About 35673 specimens were submitted to Debre Markos comprehensive specialized hospital laboratory during January 2020 to December 2023, of which 420 (1.38%) plasma specimens for viral load, 18 (1.61%) DBS specimens for EID, 4 (0.20%) sputum specimens for gene expert, 118 (5.41%) whole blood specimens for CD4 count and totally 560 (1.57%) laboratory specimens were rejected because of different pre analytical errors. The majority of the referred specimens, 30429 (85.3%), were for viral load testing to monitor effectiveness of HIV anti-retroviral drugs. Specimen rejection rate varied among requested tests. The highest specimen rejection rate 118 (5.41%) was seen among specimens referred for CD4 count and the least specimen rejection rate 4 (0.20%) was seen among specimens referred for gene expert test (Table 1 ). Table 1 Laboratory specimen rejection rate for each type of requested laboratory tests from January 2020 to December 2023 Status of specimen Requested laboratory test type Total Viral load EID Gene expert CD4 count Total specimens referred 30429 1110 1955 2179 35673 Rejected specimens 420 18 4 118 560 Specimen rejection rate (%) 1.38 1.61 0.20 5.41 1.57 Total specimen rejection rates in each year were 2.30%, 1.59%, 1.42% and 1.26% respectively from 2020 to 2023 (Table 2 ) Table 2 Laboratory specimen rejection rate among referred specimens in each year from 2020 to 2023 Status of specimen Years Total 2020 2021 2022 2023 Total specimens referred 6009 9477 10143 10044 35673 Rejected specimens 138 151 144 127 560 Specimen rejection rate (%) 2.30 1.59 1.42 1.26 1.57 This study showed that the trends of laboratory specimen rejection among referred laboratory specimens was gradually improved through time (Fig. 1 ). The main reasons of specimen rejection were hemolysis (28.6%), insufficient volume (22.5%), repeated labeling (9.5%) and clotted specimen (8.0%) (Table 3 ). Table 3 Reasons of laboratory specimen rejection among referred specimens from January 2020 to December 2023 Reason of rejection Years specimen rejected Percentage (%) 2020 2021 2022 2023 Hemolysis 39 43 41 37 160 28.6 Insufficient volume 31 34 32 29 126 22.5 Repeated labeling 13 14 14 12 53 9.5 Clotted specimen 11 12 12 10 45 8.0 Delayed time 10 11 11 10 42 7.5 Inappropriate specimen container 8 9 8 8 33 5.9 Unlabeled specimen 6 7 6 6 25 4.5 Requested paper without specimen 6 6 6 5 23 4.1 Not maintain cold chain 5 5 5 4 19 3.4 Mismatch label 4 4 4 3 15 2.7 Specimen without request paper 3 3 3 3 12 2.1 Others 2 2 2 1 7 1.2 Total 138 151 144 127 560 100 Discussion We conducted a four-years document review study to evaluate the trends of laboratory specimen rejection rates among referred laboratory specimens Our finding showed that the overall laboratory specimen rejection rate was 1.57% and the specimen rejection rate in each year were 2.30%, 1.59%, 1.42% and 1.26% from 2020 to 2023 respectively. Many national and international programs to track laboratory quality have reported laboratory specimen rejection rates ranging from 0.3% in outpatient facilities to 0.83% in hospital based laboratories ( 9 ). Thus, Debre Markos comprehensive specialized hospital laboratory has established target specimen rejection rate as to be below 0.3% as quality indicator. Hence, the overall laboratory specimen rejection rate (1.57%) needs to be improved because it has been above the established target specimen rejection rate (0.3%). The main reason of specimen rejection that we investigated in our study is hemolysis, which covers about 29% of the total rejected specimens. In the same manner, a retrospective study conducted by Ata’o( 10 ) in pathology department in Port Moresby general hospital to investigate the major cause of pre analytical errors that led to sample rejection at clinical biochemistry department revealed that samples with visible hemolysis after centrifugation was the most common cause accounting for 35% of total rejection. In addition, a cross sectional study conducted by Molla( 11 ) at St. Paul’s Hospital millennium Medical College, Addis Ababa also noted that the main reason of specimen rejection was hemolysis. Hemolysis may result from inappropriate drawing and transferring of the specimen to collection tubes and results from transportation of specimen without centrifugation. In our study the other main reason of specimen’s rejection (almost 22%) was rejected due to insufficient volume. In the same manner, a cross-sectional study done by Chiku( 12 ) showed that the main reason of specimen rejection was in sufficient volume, which covers 72% of the total rejected specimens. Moreover, a cross sectional study that was conducted by Mehrotra( 13 ) also revealed that the main reason of rejection was due to inadequacy of specimen collection by paramedical staff. This reason of specimen rejection is directly related to the technical errors of specimen collectors. They didn’t know how much specimen volume is required for the respective test or they have poor skill to collect enough amounts of specimens for the requested test. Conclusion and recommendation This study demonstrated an improvement in laboratory specimen rejection rates over four years; however, the overall rejection rate remained higher than the standard (0.3%). To further minimize specimen rejection and improve laboratory service quality, additional interventions are needed in specimen collection, handling, and transportation. Declarations Ethical approval and consent Ethical clearance to conduct the study was obtained from the department of medical laboratory science research and ethics committee, Addis Ababa University. Informed consent was also obtained from Debre Markos referral hospital laboratory Data and material availability For our study, we used secondary data and are available from the corresponding author upon request. Competing Interests We declare that we have no competing interests concerning our study and publication. Author Contribution B.M. and K.M. wrote the main manuscript text and M.B. prepared table 1-3 and figure 1. All authors reviewed the manuscript References International Organization for Standardization. Medical laboratories–Requirements for quality and competence 2012 [Available from: https://www.qal-iran.ir/WebsiteImages/iso/18.PDF World Health Organization. Guidance for Establishing a National Health Laboratory System. 2015. Ambachew S, Adane K, Worede A, Melak T, Asmelash D, Damtie S, et al. Errors in the total testing process in the clinical chemistry laboratory at the University of Gondar Hospital, Northwest Ethiopia. Ethiop J health Sci. 2018;28(2):235–44. Lippi G, Banfi G, Church S, Cornes M, De Carli G, Grankvist K, et al. Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE). Clin Chem Lab Med (CCLM). 2015;53(3):357–70. Shiferaw MB, Yismaw G, Getachew H. Specimen rejections among referred specimens through referral network to the Amhara Public Health Institute for laboratory testing, Bahir Dar, Ethiopia. BMC Res Notes. 2018;11(1):1–6. World Health Organization. Laboratory quality management system: handbook. World Health Organization; 2011. Karcher DS, Lehman CM. Clinical consequences of specimen rejection: a College of American Pathologists Q-Probes analysis of 78 clinical laboratories. Arch Pathol Lab Med. 2014;138(8):1003–8. Kebede Y, Fonjungo PN, Tibesso G, Shrivastava R, Nkengasong JN, Kenyon T, et al. Improved specimen-referral system and increased access to quality laboratory services in Ethiopia: the role of the public-private partnership. J Infect Dis. 2016;213(suppl2):S59–64. Dale JC, Novis DA. Outpatient phlebotomy success and reasons for specimen rejection: a Q-Probes study. Arch Pathol Lab Med. 2002;126(4):416–9. Ata'o m. pusahai-riman p. rate of rejection of haematology samples in pathology department in port moresby general hospital: a retrospective study. pacific journal of medical sciences.3. Tesfaw HM, Segaye A, Hassen F. Frequency of Specimen Rejection and A ssociated F actors at St. Paul’s Hospital Millennium Medical College, Addis Ababa Ethiopia. J Multidisciplinary Res Healthc. 2015;2(1):1–16. Chiku C, Zolfo M, Senkoro M, Mabhala M, Tweya H, Musasa P, et al. Common causes of EID sample rejection in Zimbabwe and how to mitigate them. PLoS ONE. 2019;14(8):e0210136. Mehrotra A, Srivastava K, Bais P. An evaluation of laboratory specimen rejection rate in a North Indian setting-a cross-sectional study. Iosr-Jdms. 2013;7(2):35–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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-6361690","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437458429,"identity":"88a9adae-acf6-4d29-8dfa-f8295f182b6d","order_by":0,"name":"Bewket Mesganaw","email":"data:image/png;base64,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","orcid":"","institution":"Debre Markos University","correspondingAuthor":true,"prefix":"","firstName":"Bewket","middleName":"","lastName":"Mesganaw","suffix":""},{"id":437458430,"identity":"02ab1ece-350b-4ea8-93c9-2ca76941c1f4","order_by":1,"name":"Ketema Misganaw","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Ketema","middleName":"","lastName":"Misganaw","suffix":""},{"id":437458431,"identity":"e084e9f9-0588-46b0-9b4b-33f28cd8ae22","order_by":2,"name":"Mekuriaw Belayneh","email":"","orcid":"","institution":"Debre Markos University","correspondingAuthor":false,"prefix":"","firstName":"Mekuriaw","middleName":"","lastName":"Belayneh","suffix":""}],"badges":[],"createdAt":"2025-04-02 13:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6361690/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6361690/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80042712,"identity":"cd28a27e-011d-494c-a405-c49c93e13bf6","added_by":"auto","created_at":"2025-04-07 09:30:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4233,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTrends of laboratory specimen rejection rates at specialized hospital in Ethiopia from 2020 to 2023\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6361690/v1/aa8cc1a2ae638c5af4dadf1f.png"},{"id":80047278,"identity":"6c87b1c2-0974-4a19-96c1-a33ab62923c0","added_by":"auto","created_at":"2025-04-07 09:54:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":658656,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6361690/v1/d69f54f1-e7a6-449d-8637-2cf3646568d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trend analysis of laboratory specimen rejection rates at Debre Markos comprehensive specialized hospital, North West Ethiopia: Four-years document review","fulltext":[{"header":"Background","content":"\u003cp\u003eClinical laboratories are an essential and fundamental part of all health systems, aiming to improve health outcomes. To ensure effective treatment for patients, establishing and maintaining a laboratory quality management system is mandatory (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLaboratory errors, which are defects throughout the entire laboratory testing process, can negatively affect the clinical decision-making process. Several studies have shown that the majority of these errors originate from the manually intensive activities of the pre-analytical phase, mainly related to the collection, handling, transportation, preparation, and storage of diagnostic specimens (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImproper sample collection may lead to poor outcomes, such as incorrect diagnosis, inappropriate treatment, and even death. Problems such as incorrect patient or sample identification, sample instability due to transport delays or inappropriate containers, insufficient sample volume, and clotted or hemolyzed samples are some examples of criteria for rejection (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSpecimen rejection may have clinically significant consequences for patients. Patients whose specimens are rejected are mostly subjected to repeated specimen collection, resulting inconvenience, and the discomfort of repeated phlebotomy (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the implementation of specimen referral system, specimens are collected from any health facility and transported via a suitable courier system to referral laboratories where the testing service is available (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDebre Markos Comprehensive Specialized Hospital Laboratory serves as one of the referral laboratories to which surrounding health facilities send specimens for testing, especially for viral load, GeneXpert for tuberculosis (TB), Early Infant Diagnosis (EID) for HIV, and CD4 testing. However, no study has been conducted in the area to gather detailed information about the trends in laboratory specimen rejection. Therefore, the aim of this study was to assess the trends of laboratory specimen rejection among referred specimens at Debre Markos Comprehensive Specialized Hospital Laboratory.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design, setting and participants\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eA four-years document review was conducted from January 2020 to December 2023 at Debre Markos comprehensive specialized hospital. Under Debre Markos comprehensive specialized hospital laboratory 56 health facilities were linked for referral network. These were 9 district hospitals, 46 health centers and 1 private clinic. All referred specimens were included as study participants. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData source and procedures\u003c/h2\u003e\n\u003cp\u003eRecords of laboratory specimens at Debre Markos comprehensive specialized hospital laboratory from 2020 to 2023 were included and reviewed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData extraction checklist was prepared and used to collect information regarding specimen rejection from the specimen receiving and rejection logbook. After training and brief orientation for data collectors, data was collected using the prepared extraction tool.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData variables\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variables:\u003c/strong\u003e specimen rejection rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables:\u003c/strong\u003e specimen type, requested laboratory test type and reasons for rejections which includes hemolysis, inadequate volume, clotted specimen, unlabeled specimen, samples with no request paper,\u0026nbsp;delayed time, not maintained cold chain, Contaminated specimen, inappropriate specimen container\u003c/p\u003e\n\u003ch2\u003eStatistical analyses\u003c/h2\u003e\n\u003cp\u003eThe collected data was transferred to Statistical Package for Social Sciences (SPSS) 22.0 software. The number of rejected specimens per total referred specimens submitted was calculated to estimate the overall laboratory specimen rejection rate. Other descriptive statistics was also done to show the reasons and problems related to specimen rejection among referred laboratory specimens.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAbout 35673 specimens were submitted to Debre Markos comprehensive specialized hospital laboratory during January 2020 to December 2023, of which 420 (1.38%) plasma specimens for viral load, 18 (1.61%) DBS specimens for EID, 4 (0.20%) sputum specimens for gene expert, 118 (5.41%) whole blood specimens for CD4 count and totally 560 (1.57%) laboratory specimens were rejected because of different pre analytical errors. The majority of the referred specimens, 30429 (85.3%), were for viral load testing to monitor effectiveness of HIV anti-retroviral drugs. Specimen rejection rate varied among requested tests. The highest specimen rejection rate 118 (5.41%) was seen among specimens referred for CD4 count and the least specimen rejection rate 4 (0.20%) was seen among specimens referred for gene expert test (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\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\u003eLaboratory specimen rejection rate for each type of requested laboratory tests from January 2020 to December 2023\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\"\u003e \u003cp\u003eStatus of specimen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eRequested laboratory test type\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=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eViral load\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGene expert\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCD4 count\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal specimens referred\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRejected specimens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\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\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecimen rejection rate (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.57\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\u003eTotal specimen rejection rates in each year were 2.30%, 1.59%, 1.42% and 1.26% respectively from 2020 to 2023 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\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\u003eLaboratory specimen rejection rate among referred specimens in each year from 2020 to 2023\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\"\u003e \u003cp\u003eStatus of specimen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eYears\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=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal specimens referred\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRejected specimens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecimen rejection rate (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.57\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\u003eThis study showed that the trends of laboratory specimen rejection among referred laboratory specimens was gradually improved through time (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe main reasons of specimen rejection were hemolysis (28.6%), insufficient volume (22.5%), repeated labeling (9.5%) and clotted specimen (8.0%) (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\u003eReasons of laboratory specimen rejection among referred specimens from January 2020 to December 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason of rejection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003especimen rejected\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemolysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepeated labeling\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\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClotted specimen\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\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\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\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\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\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInappropriate specimen container\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\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnlabeled specimen\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\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRequested paper without specimen\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\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\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\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot maintain cold chain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMismatch label\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\u003e4\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecimen without request paper\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\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\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\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\u003e2\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\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.2\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\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe conducted a four-years document review study to evaluate the trends of laboratory specimen rejection rates among referred laboratory specimens\u003c/p\u003e \u003cp\u003eOur finding showed that the overall laboratory specimen rejection rate was 1.57% and the specimen rejection rate in each year were 2.30%, 1.59%, 1.42% and 1.26% from 2020 to 2023 respectively. Many national and international programs to track laboratory quality have reported laboratory specimen rejection rates ranging from 0.3% in outpatient facilities to 0.83% in hospital based laboratories (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Thus, Debre Markos comprehensive specialized hospital laboratory has established target specimen rejection rate as to be below 0.3% as quality indicator. Hence, the overall laboratory specimen rejection rate (1.57%) needs to be improved because it has been above the established target specimen rejection rate (0.3%).\u003c/p\u003e \u003cp\u003eThe main reason of specimen rejection that we investigated in our study is hemolysis, which covers about 29% of the total rejected specimens. In the same manner, a retrospective study conducted by Ata\u0026rsquo;o(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) in pathology department in Port Moresby general hospital to investigate the major cause of pre analytical errors that led to sample rejection at clinical biochemistry department revealed that samples with visible hemolysis after centrifugation was the most common cause accounting for 35% of total rejection. In addition, a cross sectional study conducted by Molla(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) at St. Paul\u0026rsquo;s Hospital millennium Medical College, Addis Ababa also noted that the main reason of specimen rejection was hemolysis. Hemolysis may result from inappropriate drawing and transferring of the specimen to collection tubes and results from transportation of specimen without centrifugation.\u003c/p\u003e \u003cp\u003eIn our study the other main reason of specimen\u0026rsquo;s rejection (almost 22%) was rejected due to insufficient volume. In the same manner, a cross-sectional study done by Chiku(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) showed that the main reason of specimen rejection was in sufficient volume, which covers 72% of the total rejected specimens. Moreover, a cross sectional study that was conducted by Mehrotra(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) also revealed that the main reason of rejection was due to inadequacy of specimen collection by paramedical staff. This reason of specimen rejection is directly related to the technical errors of specimen collectors. They didn\u0026rsquo;t know how much specimen volume is required for the respective test or they have poor skill to collect enough amounts of specimens for the requested test.\u003c/p\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eThis study demonstrated an improvement in laboratory specimen rejection rates over four years; however, the overall rejection rate remained higher than the standard (0.3%). To further minimize specimen rejection and improve laboratory service quality, additional interventions are needed in specimen collection, handling, and transportation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical approval and consent\u003c/h2\u003e\n\u003cp\u003eEthical clearance to conduct the study was obtained from the department of medical laboratory science research and ethics committee, Addis Ababa University. Informed consent was also obtained from Debre Markos referral hospital laboratory\u003c/p\u003e\n\u003ch2\u003eData and material availability\u003c/h2\u003e\n\u003cp\u003eFor our study, we used secondary data and are available from the corresponding author upon request.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eWe declare that we have no competing interests concerning our study and publication.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eB.M. and K.M. wrote the main manuscript text and M.B. prepared table 1-3 and figure 1. All authors reviewed the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInternational Organization for Standardization. Medical laboratories\u0026ndash;Requirements for quality and competence 2012 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.qal-iran.ir/WebsiteImages/iso/18.PDF\u003c/span\u003e\u003cspan address=\"https://www.qal-iran.ir/WebsiteImages/iso/18.PDF\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Guidance for Establishing a National Health Laboratory System. 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmbachew S, Adane K, Worede A, Melak T, Asmelash D, Damtie S, et al. Errors in the total testing process in the clinical chemistry laboratory at the University of Gondar Hospital, Northwest Ethiopia. Ethiop J health Sci. 2018;28(2):235\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLippi G, Banfi G, Church S, Cornes M, De Carli G, Grankvist K, et al. Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE). Clin Chem Lab Med (CCLM). 2015;53(3):357\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiferaw MB, Yismaw G, Getachew H. Specimen rejections among referred specimens through referral network to the Amhara Public Health Institute for laboratory testing, Bahir Dar, Ethiopia. BMC Res Notes. 2018;11(1):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Laboratory quality management system: handbook. World Health Organization; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarcher DS, Lehman CM. Clinical consequences of specimen rejection: a College of American Pathologists Q-Probes analysis of 78 clinical laboratories. Arch Pathol Lab Med. 2014;138(8):1003\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKebede Y, Fonjungo PN, Tibesso G, Shrivastava R, Nkengasong JN, Kenyon T, et al. Improved specimen-referral system and increased access to quality laboratory services in Ethiopia: the role of the public-private partnership. J Infect Dis. 2016;213(suppl2):S59\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDale JC, Novis DA. Outpatient phlebotomy success and reasons for specimen rejection: a Q-Probes study. Arch Pathol Lab Med. 2002;126(4):416\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAta'o m. pusahai-riman p. rate of rejection of haematology samples in pathology department in port moresby general hospital: a retrospective study. pacific journal of medical sciences.3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesfaw HM, Segaye A, Hassen F. Frequency of Specimen Rejection and A ssociated F actors at St. Paul\u0026rsquo;s Hospital Millennium Medical College, Addis Ababa Ethiopia. J Multidisciplinary Res Healthc. 2015;2(1):1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiku C, Zolfo M, Senkoro M, Mabhala M, Tweya H, Musasa P, et al. Common causes of EID sample rejection in Zimbabwe and how to mitigate them. PLoS ONE. 2019;14(8):e0210136.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehrotra A, Srivastava K, Bais P. An evaluation of laboratory specimen rejection rate in a North Indian setting-a cross-sectional study. Iosr-Jdms. 2013;7(2):35\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"specimen rejection rate, clinical laboratory errors, laboratory quality management system","lastPublishedDoi":"10.21203/rs.3.rs-6361690/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6361690/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Clinical laboratory errors can be classified into pre-analytical, analytical, and post-analytical phases. The majority of laboratory errors originate from the manually intensive activities of the pre-analytical phase, primarily those related to the collection, handling, transportation, preparation, and storage of diagnostic specimens.\u003c/p\u003e\n\u003cp\u003eObjective: The aim of this study was to assess the trend of laboratory specimen rejection rates at a specialized hospital in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: A four-year document review was conducted at Debre Markos Comprehensive Specialized Hospital Laboratory from January 2020 to December 2023 to assess trends in the laboratory specimen rejection rate. Records of referred specimens for laboratory tests such as viral load, CD4 count, GeneXpert, and early infant diagnosis were included and reviewed. Finally, statistical analysis was performed using SPSS version 22.0 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOf the total 35,673 specimens submitted to the Debre Markos Comprehensive Specialized Laboratory from January 2020 to December 2023, 560 were rejected, resulting in an overall laboratory specimen rejection rate of 1.57%. The annual rejection rates were 2.30%, 1.59%, 1.42%, and 1.26%, respectively, from 2020 to 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Although the trends of laboratory specimen rejection rates among referred specimens was gradually improved from 2020 to 2023, still needs more interventions until it meets to the standard specimen rejection rate of 0.3%.\u003c/p\u003e","manuscriptTitle":"Trend analysis of laboratory specimen rejection rates at Debre Markos comprehensive specialized hospital, North West Ethiopia: Four-years document review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-07 09:30:25","doi":"10.21203/rs.3.rs-6361690/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d45c177-6dab-43d2-a921-96db4395af14","owner":[],"postedDate":"April 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-15T08:23:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-07 09:30:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6361690","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6361690","identity":"rs-6361690","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}