A Toronto laboratory was seeing a steady rejection rate on send-out specimens, and the rejections were not caused by the tests. The audit traced most of them to the label and the closure rather than to the sample, and both were decided at the bench where the specimen was collected rather than at the lab that received it.
The container that moved most often was the 90 mL graduated leak-proof specimen cup, and the closure check on that line turned out to be the single change with the largest effect.
How was the rejection pattern audited?
The lab pulled the rejection reasons it had issued over a quarter and sorted them by cause and by collection point. Two causes accounted for most of the total. The first was identification: a label on the transport bag rather than on the container, which left the lab unable to match the sample once the bag was opened. The second was containment: a container that had leaked in transit, which the lab saw at receipt but which had started as a lid that was not fully seated at the bench. Neither cause was visible in a monthly rejection percentage, and both became obvious once the reasons were sorted rather than counted.
Which changes removed most rejections?
The first change moved labelling to the bench, so the container was labelled as the specimen was collected and before it went into the bag. The second added a closure check to the routine, turning the cap until the thread stopped and confirming the gasket line had compressed evenly. The third was a stock change: the three-wall transport bag was brought in beside the container, so the two were always used as a pair rather than being drawn from different cabinets.
| Measure | Before | After the changes |
|---|---|---|
| Label placement | Often on the bag | On the container, at the bench |
| Closure check | Trusted to habit | Thread to the stop, gasket line checked |
| Container and bag | Stored separately | Stocked as a pair |
| Rejection reasons | Counted per month | Sorted by cause and collection point |
| Review | Annual | When a reason repeats |
What did the bench routine look like afterwards?
Collection and labelling became one action, so the container carried the identification before it left the hand that drew the sample. The bag was taken from the same shelf as the container, which removed the search that used to end with a bag from a different size. Where more than one specimen was drawn in a run, each container was labelled before the next was opened, which is the practice that stops two containers from being confused in a busy morning.
How do you keep the improvement in place?
The rejection reasons are reviewed whenever the same reason appears twice, rather than at a fixed date, because a repeating cause is the signal worth acting on. New staff are taught the labelling step as part of collection rather than as a separate task, and the closure check is demonstrated once at the bench. Keeping the container and the bag on one shelf is the part that needs least maintenance, because the stock layout does the reminding.
A wider view of transport rules sits in ordering specimen transport bags and containers in Ontario, and a similar improvement is described in a Vancouver lab's specimen rejection and turnaround case review. The transport layer is the three-wall specimen transport bag.
Related Reading
- Ordering specimen transport bags and containers in Ontario
- A Vancouver lab's specimen rejection and turnaround case review
- Stock and order log
- Ask a sterilization compliance specialist
Frequently Asked Questions
Why are specimens rejected at the lab?
Rejection usually comes from identification or containment rather than from the specimen itself. A label on the bag instead of the container, a missing date or time, or a leak in transit accounts for most rejections, and all three are decided at the bench.
Should the label go on the container or the bag?
On the container. The bag is a transport layer, and a label on the bag separates from the specimen as soon as the bag is opened, which is the point at which the lab loses the link between the sample and the request.
How does labelling at the bench reduce rejections?
It removes the step where containers wait to be labelled, which is where a container from one patient is mislabelled with another patient's details. Labelling as the specimen is collected ties the two together without a queue in between.
What should be recorded when a rejection does happen?
The reason the lab gave, the line and the collection point, so the same cause can be checked rather than guessed. One rejection rarely means a system problem; the same reason appearing twice does.
Ordering for a clinic, lab or care home? Wholesale and multi-site ordering covers case pricing and account setup, and the B2B wholesale collection lists the lines stocked for institutional buyers. Reselling? become a distributor.
Download the printable stock and order log, run the log generator to track par levels, request a biological indicator sample, or ask a sterilization compliance specialist to review your monitoring routine.
CliniEco Medical is a licensed medical device establishment (MDEL #35334).
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