Reacting to spontaneous feedback from external customers in a university hospital laboratory

Modern quality standards for laboratories recommend the use of customer feedback in quality improvement. Spontaneous customer feedback is one method to obtain information from customers. In the present study, we analysed the feedback data from external customers (health centres and other hospitals) to our university hospital laboratory during 2001–2006. The most common subject matters of the feedback, covering 87% of a total of 95 reports, were lacking test results, suspicion of the validity of test results, return of samples in transportation boxes to customers and delays in service. On investigation, errors or defects were revealed in 78 cases. The most common errors were lacking (45 cases; 58%), erroneous (20 cases; 26%) or delayed test results (7 cases; 9%). As much as 68% of these errors took place in the pre-analytical phase of the laboratory process, occurring most commonly during specimen transfer, when entering orders into the laboratory information system at the university hospital or during sample processing. The most common underlying causes for errors were unintended errors and non-compliance with operating instructions. Latent errors were identified in 14% of the cases. Corrective actions were performed in 79% of the reported cases. It is important that the feedback reports are investigated to find out possible errors and their underlying causes so that appropriate corrective actions can be taken. When processed properly, spontaneous customer feedback is a method that can be used supplementarily to other methods to detect errors and defects in clinical laboratories and to aid in quality improvement.