2025 analysis

HQE Specimen Rejection Analysis: Chemical Pathology 2025

1. Overall Rejection Rates

Inpatient specimen rejection rates were consistently higher than those for outpatient and outstation samples across all four quarters in 2025:

Jan–Mar: Inpatient 2.61% vs Outpatient/Outstation 0.78% 

Apr–Jun: Inpatient 2.30% vs Outpatient/Outstation 0.63% 

Jul–Sep: Inpatient 2.30% vs Outpatient/Outstation 0.80% 

Oct–Dec: Inpatient 2.12% vs Outpatient/Outstation 0.96% 

2. Top Reasons for Specimen Rejection (Overall)

Repeated Test Requests

The leading cause of specimen rejection across Q1–Q3 for both inpatient and outpatient categories.

Quarterly Rejected Samples Due to Repeats:

Jan–Mar: 3,412 samples 

Apr–Jun: 3,894 samples 

Jul–Sep: 5,755 samples 

Oct–Dec: 4,136 samples 

Test Not Offered

Surged as the #1 overall rejection cause in Q4 due to temporary service suspensions implemented for laboratory cost optimization and resource prioritization in the last quarter of 2025.

Quarterly Rejected Samples:

Jan–Mar: 15 samples 

Apr–Jun: 4 samples

Jul–Sep: 108 samples 

Oct–Dec: 7,534 samples 

Test Not Indicated

Regular contributor to rejections, occurring when clinical history is incomplete or required specialist authorization is missing.

Quarterly Rejected Samples:

Jan–Mar: 589 samples 

Apr–Jun: 837 samples 

Jul–Sep: 1,170 samples 

Oct–Dec: 657 samples 

Blood Clotted

Particularly prevalent in inpatient samples and primarily associated with blood gas tests collected in heparinized syringes and routine blood tubes.

Quarterly Rejected Samples:

Jan–Mar: 643 samples

Apr–Jun: 697 samples 

Jul–Sep: 461 samples

Oct–Dec: 479 samples 

Hemolysed Samples

Prominent in both outpatient and inpatient settings, caused by venipuncture technique errors and specimen transport delay.

Quarterly Rejected Samples:

Jan–Mar: 270 samples

Apr–Jun: 220 samples 

Jul–Sep: 532 samples 

Oct–Dec: 368 samples 

No Sample Received

Consistently affects outpatient and outstation requests (e.g., missing fluoride oxalate tubes or unreceived plasma).

Quarterly Rejected Samples:

Jan–Mar: 354 samples 

Apr–Jun: 325 samples 

Jul–Sep: 355 samples 

Oct–Dec: 336 samples 

Other Notable Causes

1. Wrong Container/Fixative

2. Decomposed / Degenerated Specimens

3. Improper Specimen Volume

3. Top Contributing Locations

1. Emergency Department – Yellow Zone (YZ): Consistently ranked as the #1 overall contributing location across all four quarters (461 in Q1, 432 in Q2, 479 in Q3, 770 in Q4).

2. General Medical Wards (GM1, GM2, GM3, GM4): Maintained high overall rejection volumes throughout the year, driven mainly by repeated test requests and clotted specimens.

3. High Dependency Ward (HDW) & Resuscitation (RESUS / RZ): Recurrent high rejection contributors, particularly for clotted blood gas syringes.

4. Outpatient Clinics (Urology Clinic & Gastroenterology Clinic): Entered the top contributing list in Q4 (URO: 402, GASC: 368) due to the temporary suspension of specific non-routine tests ("Test Not Offered").

5. Other Notable Units: Haematology Ward (HAEW), Nephrology Clinic (NEPC), and General Surgical Wards (GSW1, GSW3).

4. Corrective Actions

1. Repeated Tests: Enforce minimum retesting intervals specified in the Lab Handbook 

2. Test Not Offered: Refer to lab communications and circulars regarding test suspension periods and resumption dates.

3. Clotted Samples: Improve blood gas collection techniques:

   1. Lubricate syringe with heparin and expel excess heparin completely

   2. Mix immediately post-sampling by repeatedly inverting and rolling between palms.

   3. Transport immediately in an ice-water slurry to be analyzed within 30 minutes.

4. Test Not Indicated: Screen special biochemistry requests against clinical history; require complete clinical details and official specialist signatures/stamps for referred tests.

5. Hemolysed Samples: Improve phlebotomy practices.:

   1. Use 21–23G needles.

   2. Allow alcohol swabs to air dry for ~30 seconds.

   3. Keep tourniquet time under 1 minute.

   4. Avoid forcible aspiration/transfer, fill tubes to proper volume, and transport promptly.

6. Add-On Test Procedures: Require add-on requests within 3 hours for routine biochemistry to prevent specimen degeneration.

5. Conclusion

Throughout 2025, repeated test requests remained the predominant cause of specimen rejection for Q1–Q3, alongside clotted blood gas samples, test not indicated, hemolysis, and unreceived specimens. A temporary service suspension in Q4 led to a temporary spike in rejections. Overall inpatient rejection rates showed an encouraging decline from 2.61% in Q1 to 2.12% in Q4 2025. Continued adherence to minimum retesting intervals, phlebotomy best practices, and complete clinical documentation remains essential for sustained quality improvement across all HQE clinical units.