Optimising Laboratory Efficiency by Reducing Pre-Analytical Redo Testing: Impact of a Structured Staff Training Intervention in Urban and Rural Hospital Biochemistry Laboratories

Background: Pre-analytical errors are a major source of laboratory errors and can lead to specimen rejection, repeat testing, delayed diagnosis, increased healthcare expenditure, and compromised patient safety. Competency-based education may improve healthcare workers’ practices and strengthen laboratory quality. However, evidence comparing its effectiveness in urban and rural healthcare settings remains limited. Materials and Methods: A retrospective quasi-experimental pre- and post-intervention comparative study was conducted in the biochemistry laboratories of one urban tertiary-care teaching hospital and one rural secondary-care hospital in West Bengal, India. The study included 49,524 laboratory specimens and 65 healthcare personnel involved in pre-analytical activities. A structured competency-based educational programme covering patient identification, specimen collection, labelling, transportation, specimen acceptance and rejection, prevention of haemolysis and clots, quality assurance, documentation, and incident reporting was implemented. Pre-analytical redo rates, staff competency scores, and repeat-testing expenditure were assessed before and after the intervention. Wilcoxon signed-rank test and linear regression were used for statistical analysis. Results: The urban laboratory redo rate decreased from 0.2693% to 0.0700%, representing a 74.0% reduction, while the rural laboratory rate decreased from 4.0087% to 1.6415%, representing a 59.1% reduction. A significant downward trend in monthly redo rates was observed in both the urban laboratory (R² = 0.799, p = 0.0028) and rural laboratory (R² = 0.668, p = 0.0132). Staff competency improved significantly in three of the four assessed groups. In the urban laboratory, competency increased among technologists from 8.13 ± 1.41 to 16.80 ± 1.45 (p < 0.001) and nursing personnel from 5.05 ± 1.61 to 14.95 ± 1.39 (p < 0.001). Rural nursing personnel improved from 4.60 ± 2.12 to 11.60 ± 2.80 (p = 0.0019). The urban laboratory achieved a net saving of ₹9,263, whereas the rural laboratory incurred an additional ₹135,963 in repeat-testing expenditure because of increased specimen workload. Conclusion: The structured competency-based educational programme was associated with improved staff competency and substantial reductions in pre-analytical laboratory redo rates in both urban and rural settings. The findings suggest that competency-based education can strengthen laboratory quality and patient safety; however, sustained improvement requires continuous quality monitoring, appropriate workload management, supervision, adequate infrastructure, adherence to standard operating procedures, and an effective laboratory quality management system.

Keywords: Pre-analytical errors; competency-based education; laboratory quality; specimen rejection; patient safety; quality improvement.