TABLE 3.
Classification of 32 laboratory-related adverse events by specific clinical impact, responsibility for error, phase of laboratory testing involved, preventability, and error type if the error was preventable
| Classification of 32 laboratory-related adverse events | No. of cases (% of total) |
|---|---|
| Patient outcome and specific injury | |
| Delayed drug therapy | 19 (59.4) |
| Inappropriate drug therapy | 8 (25.0) |
| Unnecessary drug therapy | 8 (25.0) |
| Unnecessary invasive procedure or test | 1 (3.1) |
| Transient morbiditya lasting <1 week | 5 (15.6) |
| Morbiditya lasting >1 week | 1 (3.1) |
| Increased level of carea | 4 (12.5) |
| Responsibility for the error | |
| Laboratory alone | 28 (87.5) |
| Nonlaboratory alone | 0 (0) |
| Both laboratory and nonlaboratory | 4 (12.5) |
| Phase of testing involved | |
| Preanalytic | 0 (0) |
| Analytic | 31 (96.9) |
| Postanalytic | 1 (3.1) |
| Preventability | |
| No | 4 (12.5) |
| Yes | 28 (87.5) |
| Yes, cognitive error | 26 (81.3) |
| Yes, noncognitive error | 2 (6.3) |
a
See text for definition.