A quality improvement re-audit on incomplete microbiology laboratory request forms at a University Hospital in Sri Lanka: Targeted interventions and five-year outcomes

Introduction:  The clinical laboratory plays a vital role in patient care, yet preanalytical errors, especially incomplete request forms, can compromise diagnostic accuracy. This study assesses the impact of targeted interventions over five years on achieving measurable improvements in the completeness of microbiology request forms at a university hospital in Sri Lanka.
Methods: A retrospective cross-sectional re-audit was conducted following interventions from October to December 2024. A total of 1,176 blood and urine culture request forms during this period were assessed for incom-pleteness and compared with 2,087 forms from a 2019 audit. Interventions included disseminating 2019 audit results, developing and distributing guidelines, unit-level pocket meetings for interns and nurses, mandatory intern training, and individual feedback. Incomplete forms were added to the rejection criteria, and laboratory staff were trained to ensure compliance.
Results: Between 2019 and 2024, significant improvements were observed in laboratory form completion. Incompletion of patient age decreased from 1.8% to 0.9% (p=0.043), gender from 18.2% to 5.1% (p < 0.001), and Bed Head Ticket (BHT) number from 1.8% to 0.17% (p<0.001). Clinical history omissions dropped from 40.2% to 25.4% (p< 0.001), and test request fields improved from 0.6% to 0% (p< 0.001). However, specimen time (96.4% to 100%, p< 0.001) and type (55.2% to 66.7%, p<0.001) documentation worsened.
Conclusions: The audit shows marked improvement in form completeness following targeted interventions. Continued education, regular audits, and feedback are essential. Understanding and completing the clinical audit loop is an efficient way of quality improvement in clinical laboratory processes. Future focus for more sustainable digital transformations would also ensure accuracy and efficiency of laboratory diagnostics and patient safety.