Quality Control Circle Practices to Reduce Specimen Rejection Rates

Bijun Li,1,* Xinjian Cai,1,* Lili Zhan,1 Xiaoyu Zhang,1 Yiteng Lin,1 Jiaomei Zeng2 1Department of Clinical Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China; 2Department of Nursing, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xinjian Cai, Department of Clinical Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Baohe Road No. 113, Longgang District, Shenzhen City, Guangdong Province, People’s Republic of China, Tel +86 13411968175, Email [email protected]: Quality assurance in laboratory testing significantly impacts patient care. The pre-analytical phase is particularly error-prone, contributing to around 70% of laboratory errors. High specimen rejection rates can delay diagnosis and treatment, cause patient discomfort, and increase healthcare costs. Quality Control Circles (QCC) have been introduced to medical institutions to improve process efficiency and reduce errors. This study aims to evaluate the effectiveness of QCC practices in reducing specimen rejection rates in a hospital clinical laboratory.Methods: A QCC initiative was implemented in the clinical laboratory from July 2021 to August 2022. The QCC comprised members from the clinical laboratory, nursing department, and administration. The initiative followed the PDCA (Plan-Do-Check-Act) cycle and involved multiple quality control methods, including flowchart analysis, Pareto analysis, and Fishbone diagrams. The effectiveness of the initiative was evaluated using statistical analyses of specimen rejection rates before and after implementation.Results: The QCC initiative led to a significant reduction in specimen rejection rates. The monthly specimen rejection rate decreased from an average of 1.13% before the intervention to 0.27% after the intervention. The most significant factors contributing to specimen rejection were identified as lack of sample collection information and blood clotting. Targeted interventions, such as appointing specimen collection liaisons, establishing a quality control team, and providing training on blood collection procedures, were implemented. These measures resulted in a notable decrease in the proportion of rejected specimens due to the identified factors.Conclusion: The implementation of QCC practices effectively reduced specimen rejection rates in the hospital laboratory. The study highlights the importance of systematic quality control methods and targeted interventions in improving laboratory processes. The success of the QCC initiative demonstrates its potential for broader application in other healthcare settings to enhance quality and efficiency.Keywords: quality control circle, specimen rejection, quality improvement, PDCA cycle, Pareto analysis