The response of total testing process in clinical laboratory medicine to COVID-19 pandemic

Introduction: Following a pandemic, laboratory medicine is vulnerable to laboratory errors due to the stressful and high workloads. We aimed to examine how laboratory errors may arise from factors, e.g., flexible working order, staff displacement, changes in the number of tests, and samples will reflect on the total test process (TTP) during the pandemic period. Materials and methods: In 12 months, 6 months before and during the pandemic, laboratory errors were assessed via quality indicators (QIs) related to TTP phases. QIs were grouped as pre-, intra- and postanalytical. The results of QIs were expressed in defect percentages and sigma, evaluated with 3 levels of performance quality: 25th, 50th and 75th percentile values. Results: When the pre- and during pandemic periods were compared, the sigma value of the samples not received was significantly lower in pre-pandemic group than during pandemic group (4.7 sigma vs. 5.4 sigma, P = 0.003). The sigma values of samples transported inappropriately and haemolysed samples were significantly higher in pre-pandemic period than during pandemic (5.0 sigma vs. 4.9 sigma, 4.3 sigma vs. 4.1 sigma; P = 0.046 and P = 0.044, respectively). Sigma value of tests with inappropriate IQC performances was lower during pandemic compared to the pre-pandemic period (3.3 sigma vs. 3.2 sigma, P = 0.081). Sigma value of the reports delivered outside the specified time was higher during pandemic than pre-pandemic period (3.0 sigma vs. 3.1 sigma, P = 0.030). Conclusion: In all TTP phases, some quality indicators improved while others regressed during the pandemic period. It was observed that pre-analytical phase was affected more by the pandemic.