Pre-analytical variability and quality of diagnostic testing. Looking at the moon and gazing beyond the finger.

Laboratory diagnostics develops through a closed loop, formerly defined as the “brain-to-brain turnaround time”, which entails pre-analytical, analytical and post-analytical phases. After decades of research into total quality of laboratory testing, it is now undeniable that the pre-analytical phase is most vulnerable to a variety of errors, which may ultimately impair the reliability of test results and jeopardize patient safety. The leading problems seemingly emerging from mishandled or poorly standardised activities include patient preparation, blood drawing, sample handling, transportation and preparation. Therefore, the aim of this review article it to provide a succinct update of the state-of-the-art of pre-analytical variability according to personal practice and experience, and then to suggest some reliable strategies for improving awareness of the value chain of in-vitro diagnostics beyond the laboratory and into the broader system of health care.