5 Specimen Acceptance and Rejection
Learn how laboratories assess specimen suitability, apply test-specific acceptance or rejection decisions, manage exceptions, and document and communicate next steps.
Purpose of specimen acceptance
Specimen acceptance is the decision to proceed with testing after checking whether a specimen is suitable for the requested examination. Acceptability depends on the test: a specimen that is acceptable for one procedure may be unsuitable for another.
Laboratories should use written, for , collection, handling, transport, and rejection. Apply the criteria to each requested test rather than treating one condition as an automatic reason to reject every test associated with the specimen.
Assessing a specimen before testing
Before testing, compare the specimen with its order or requisition and the applicable laboratory requirements. Check each of the following:
Identification: The container is labeled legibly with required patient identifiers and, when needed, the specimen source and collection date or time. The identifiers agree with the order.
Specimen and container: The specimen type, collection device, additive or preservative, and container are appropriate for the test.
Quantity and quality: There is enough material, and its condition meets test requirements. Clotting, hemolysis, contamination, or leakage may make some tests unreliable.
Timing and conditions: The specimen is within the test’s stability limits and was transported and stored at the required temperature, with any required light protection or other conditions.
Order completeness: The requested test and other required information are present and sufficiently clear.
Common reasons for
Reject or hold a specimen for assessment when a defined requirement is not met. Common reasons include:
The specimen is unlabeled, mislabeled, illegible, or does not match the order.
The wrong specimen type, container, additive, or preservative was used.
There is insufficient material for the requested test.
The specimen is leaking, the container is broken, or the specimen may be contaminated.
Required transport or storage conditions were not followed, or the specimen arrived outside its stability period.
The specimen’s condition, such as clotting or hemolysis, makes the requested result unreliable.
The order is missing, incomplete, or unclear.
These are common examples, not universal rules. The laboratory’s procedure for the specific test determines whether a defect requires rejection, recollection, or another action.
Exceptions and identification safeguards
Some specimens, such as certain surgical tissues or cerebrospinal fluid, may be difficult or impossible to recollect. A laboratory may have an approved exception process for evaluating such an . A qualified person, such as the laboratory director or designee, must assess the risk under laboratory policy; any limitations may need to be recorded or reported. An exception is appropriate only when the applicable procedure explicitly allows it.
errors require particular caution because testing the wrong patient’s specimen can cause serious harm. Do not guess, alter a label, or accept an informal correction. Follow the authorized identification-correction or exception procedure. If identity cannot be established according to that procedure, do not test and request recollection when possible.
Documentation and communication
When a specimen is rejected, placed on hold, or accepted by exception, document the action in the laboratory information system or another approved record. Include the specimen and test involved, the specific reason, the decision and its authorizer when applicable, the time, whom the laboratory contacted, instructions given, and the submitting service’s response. Record any recollection request or agreed next step.
Notify the submitting service promptly through the laboratory’s established communication route. State which specimen or test is affected, why it cannot be processed as submitted, and whether recollection or corrected information is needed. For time-sensitive or critical specimens, communicate directly with the responsible clinical service and follow escalation procedures if the issue remains unresolved. Senders should be promptly notified when a specimen is not tested and given the reason.
For example, a blood tube may arrive underfilled for a test requiring a specific blood-to-additive ratio. Check the test’s acceptance criteria. If the specimen is unacceptable, record the reason, contact the submitting service, and request recollection. Do not report a result that the specimen condition could make unreliable.