Evaluating Pre-analytical and Post-analytical Errors in Laboratory Processes and Their Impact on Diagnostic Delay and Patient Safety in Family Medicine Referrals

Abstract

Laboratory testing is central to diagnostic decision-making in family medicine. Errors occurring outside the analytical phase — specifically in the pre-analytical and post-analytical phases — contribute a major proportion of total laboratory errors and are associated with delayed diagnoses, inappropriate or delayed therapy, increased costs, and risks to patient safety. This review synthesizes literature on the nature, frequency, causes, and consequences of pre-analytical and post-analytical errors with a focus on family medicine referrals. We evaluate common error types (mis-identification, sample collection mistakes, transport and storage, specimen hemolysis, test ordering errors, delayed or misreported results), quantify their contribution to overall error burden, and examine mechanisms whereby these errors generate diagnostic delay. Drawing on quality-indicator frameworks and published interventions (standardized test ordering, barcode labeling, electronic order entry, closed-loop critical value reporting, clinician-laboratory communication pathways), we propose a practical quality improvement bundle to reduce extra-analytical errors in primary care referral workflows. We present sample metrics, suggested tables and monitoring dashboards, and an implementation roadmap emphasizing staff training, process redesign, and IT integration. Recommendations are actionable for family medicine clinics, referral networks, and diagnostic laboratories, and aim to reduce diagnostic delay and enhance patient safety. Limitations and areas for future research are discussed.