Variables	No. (%)
Age (Year)
22-24	8 (8.3)
25-39	68 (70.8)
40-55	20 (20.8)
Sex
Male	71 (74)
Female	25 (26)
Marital status
Married	75 (78.1)
Single	21 (21.9)
Tribe
Hausa	64 (66.7)
Yoruba	11 (11.5)
Igbo	7 (7.3)
Others	12 (14.5)
Religion
Islam	86 (89.6)
Christianity	10 (10.4)
Categories of laboratory personnel
Scientist	53 (55.2)
Technician	43 (44.8)

Variables	No. (%)
Laboratory of work place
Microbiology	29 (30.2)
Chemical pathology	20 (20.8)
Histopathology	18 (18.8)
Haematology	29 (30.2)
Time since working in the laboratory (years)
Less than 5	56 (58.9)
5-10	29 (30.5)
Greater than 10	10 (10.5)
Previous laboratory working experience
Yes	54 (56.3)
No	42 (43.8)
Job in this laboratory
Performing test	64 (66.7)
Collecting specimens	34 (35.4)
Making reagents	17 (17.7)
Managing the laboratory	21 (21.9)
On-the-job training received since working in this lab
Yes	12 (12.6)
No	83 (87.4)
Type of training received
Assisted reproductive technology	2 (16.7)
Safety on fire outbreak	1(8.3)
Genotype film reading	1(8.3)
Malaria microscopy training	1(8.3)
Nigerian field epidemiology and laboratory training program	1(8.3)
Quality control of laboratory	5 (41.8)
TB/ HIV co- infection	1 (8.3)

 

Characteristics	Specifications	Yes	No
Reception area
	Standard operating procedure rejection criteria	3	1
	Handling of different samples Protocol	4	0
Main working area
Security and safety	Fire extinguishers	4	0
	Required personal protective equipment: gloves, safety boot, face mask, lab coat (disposable)	2	2
	Safety symbols	2	2
	Sample analysis room/section restricted to laboratory technical staff	4	0
	Accidents record book	2	2
	Laboratory walls and ceilings painted with washable, glossy paint	4	0
	Floor made of material easy to clean and disinfect	4	0
Work bench	Laboratory work bench top made up of ceramic tiles/wood/steel/formaker	4	0
	Work benches organized according to type of analysis/samples/pathogen	4	0
	Work benches have adequate space for bench top equipment, standard operating procedure while in use, display job aids	4	0
Cleaning of facility	How often is the laboratory floors cleaned	Daily
	How often ceilings and walls are cleaned	Weekly
	How often refrigerators and storage areas  cleaned	Monthly
	Number of laboratories with disinfection log book	2	2
Essential facilities
Patient waiting area	Laboratories with patient waiting area	1	3
Water	Running tap water	4	0
Power	Electric power	4	0
Waste disposal	Appropriate sharp objects container	3	1
	Color coded waste containers with coded bin liners	0	4
Toilet	For all staff	4	0
	For patient/client	0	4
Administration	List of members of quality control team	0	4

Variables	No. (%)
Did you ever commit error in the laboratory
Yes	66 (68.8)
No	30 (31.2)
Did you observed another laboratory staff commit error
Yes	80 (83.3)
No	16 (16.7)
Type of examination phase the error was committed
Pre- examination phase	56 (38.4)
Examination phase	54 (37.0)
Post- examination phase	36 (24.6)
Pre–examination phase errors observed
Collecting wrong sample	19 (24.1)
Mislabeling the sample	23 (29.1)
Stored sample incorrectly prior to testing	12 (15.2)
Handling samples under conditions that will damage it	17 (21.5)
Improper storage of reagents	8 (10.1)
Examination phase error observed
Failure to follow established guideline	26 (40.0)
Reporting results when quality control materials are out of range	12 (18.5)
Incorrect measuring/ dilution of sample	13 (20)
Using expired or improperly stored reagents	14 (21.5)
Post- examination phase error observed
Exchanging patient information	7 (14)
Hand written report that is illegible	7 (14)
Sending report to wrong location	5 (10)
Complete loss of report	21 (42)
Not sending the result to patient	10 (20)

Variables	No. (%)
Appropriate filling of laboratory request form by clinicians
Yes	35 (36.8)
No	60 (63.2)
Part of laboratory form frequently neglected by clinicians
Patient name	5 (5.2)
Identification number	15 (15.6)
Type of test to be performed	25 (26)
Patient medical history	28 (29.2)
Time and date of specimen collection	26 (27.2)
Name and address of requesting clinician	19 (19.8)
Primary type of specimen	8 (8.3)
Have you rejected sample because of poor labeling
Yes	73 (76.8)
No	22 (23.2)
Communicated to clinician the reason for rejection
Yes	41 (44.1)
No	52 (65.9)
Number of specimen rejected within the last three months
1-14	66 (97.1)
15-30	2 (2.9)
Reasons for specimen rejection
Specimen form not appropriately filled	27 (28.1)
Inadequate sample collected	44 (45.8)
Wrong sample collected	28 (29.2)
Inappropriate specimen container used	26 (27.1)

 

Results in table 7 show that 93% of the clinicians have received wrong results from the laboratories and nearly all of them had received between one and ten wrong results within the period under review. Most prevalent action taken by clinician was to send another sample for repeat analysis and 16.7% reported to the head of the laboratory. Three-quarters of the clinicians thought the results obtained were helpful in patient diagnosis and management; and 80% ever changed patient management in view of culture and sensitivity results obtained.
The results of table 8 show that, of the six different aspects of laboratory services assessed with respect to clinicians’ satisfaction, 58% rated length of time to get laboratory results poor. The opportunity to discuss findings with the laboratory personnel was also rated poor by 70% of the clinicians.
 

Variables	No. (%)
Age (Years)
≤ 40 years	46 (76.1)
> 40 years	14 (23.3)
Sex
Male	41 (68.3)
Female	19 (31.7)
Department
Medicine	12 (20)
Paediatrics	11(18.3)
Obstetrics and Gynaecology	13 (21.7)
Family medicine	6 (10)
Surgery	11(18.3)
Community medicine	7 (11.7)
Designation of clinicians
Consultant	8 (13.3)
Senior Resident	17 (28.3)
Junior Resident	35 (58.3)

Variables	No. (%)
Do you receive wrong results from the laboratory
Yes	56 (93.3)
No	4 (6.7)
Number of wrong result received in the last one year
≤ 5	43 (93.5)
6-10	2 (4.3)
≥ 11	1 (2.2)
Action taken on wrong result received
Reported to head of the laboratory	10 (16.7)
Send another sample for analysis	50 (83.3)
How helpful laboratory results are in patient diagnosis and treatment
Very helpful	12 (20.3)
Helpful	33 (55.9)
Somewhat helpful	14 (23.7)
Do you change patient management in view of culture and sensitivity results obtained from the laboratory
Yes	48 (80)
No	12 (20)
How often do laboratory diagnosis tally with clinical diagnosis
Most times	19 (31.7)
Sometimes	41 (68.3)
Do you send a repeat sample to laboratory outside this health facility
Yes	48 (80)
No	12 (20)
How often do you send samples to laboratories outside this health facility
Most times	2 (4.2)
Some times	44 (91.7)
Rarely	2 (4.2)

 

Characteristics	Excellent No. (%)	Very Good No. (%)	Good No. (%)	Poor No. (%)
Adequacy of information on laboratory form	4 (6.7)	27 (45.0)	26 (43.3)	3 (5.0)
General conduct of laboratory staff in relation to service	0	9 (15.0)	37 (61.7)	14 (23.3)
Length of time to get laboratory result	2 (3.3)	2 (3.3)	23 (38.3)	35 (58.4)
Reliability of laboratory result	1 (1.7)	10(16.7)	34 (56.7)	15 (25.0)
Opportunity to discuss the result finding with lab	0	4 (6.7)	14 (23.3)	42 (70.0)
Perception of the quality of laboratory service	0	5 (8.3)	38 (63.3)	17 (28.4)

Variables	Excellent  No. (%)	Good  No. (%)	Poor  No. (%)
Perception about laboratory results
Microbiology	0	24 (40)	36 (60)
Haematology	2 (3.3)	39 (65)	19 (31.7)
Chemical pathology	1(1.7)	36 (60)	23 (38.3)
Histopathology	22 (36.7)	34 (56.7)	4 (6.7)
Clinicians’ level of satisfaction with results	Very satisfied No. (%)	Satisfied No. (%)	Dissatisfied No. (%)
Microbiology	0	28 (46.7)	32 (53.4)
Haematology	2 (3.3)	41(68.3)	17(28.3)
Chemical pathology	0	40 (66.7)	20 (33.3)
Histopathology	27 (45)	29 (48.3)	4 (6.7)

Results in table 10 show that 63% of the clinician respondents expressed satisfaction with the overall laboratory services at the study centre. Chi-square test of association revealed that only respondents’ department showed a statistically significant association with satisfaction with laboratory services, (λ²= 12.12, df= 5, p< 0.03).
 
 
Table 10. Relationship between clinicians’ socio-demographic characteristics and their levels
of satisfaction with laboratory services

*Significant at p<0.05

Quality in clinical laboratory can be defined as the comprehensive and coordinated efforts to meet quality objectives [9]. However, a quality management system is defined as “coordinated activities to direct and control an organization with regard to quality.” [10] It was against this background that this study was conducted in one of the tertiary hospital in Sokoto to assess the quality of laboratory services among all the four medical laboratories of the hospital. The findings from this study revealed that the majority of the laboratory personnel are laboratory scientists, followed by laboratory technicians and medical doctors while the laboratory assistants were the least. The large number of laboratory scientist is due to the fact that there is a school of medical laboratory science at the institution, which ensures large numbers are produced every year and also in line with regulations that the cadre is required in tertiary health facilities in order to provide quality services. This is in agreement with the findings of a study at South Africa by Cohen and Rampal on the need for a quality standard for assurance in medical research laboratories [11]. The implication for the finding of a mixture of medical doctors, medical laboratory scientists and technicians working in the laboratory suggests a good composition of laboratory staff necessary for the running of a quality laboratory [12].
Our study findings show that more than two-thirds of the laboratory personnel have not received further professional training after employment with only three receiving training in laboratory quality management. The findings of the current study are in contrast with a study done by Audu et al on the experience of quality management system in clinical laboratory in Nigeria; two personnel were sent to a laboratory in Dakar, Senegal to study the implementation of quality management system and they subsequently trained thirty- three staff via regular and quality focused staff meetings [3]. The implication of this finding is that laboratory quality management is neglected to the backyard and more effort needs to be put on staff re-training especially in the issues of quality. The availability of standard operating procedures, sample rejection criteria, biosafety gadgets, fire safety equipment’s and quality managers in three-quarters of the clinical laboratories accessed from this study is heartwarming because this implies that at least there is the will to implement biosafety and some standard practices in the laboratories we accessed even though other aspects of quality management were lacking. The possession of fire safety gadgets in all the clinical laboratories accessed is in contrast with an earlier study done in Edo where only 11.3% of the laboratories had a fire extinguisher [13]. We advocate that special emphasis should be paid to biosafety requirements in the clinical laboratories in line with international guidelines.
This study shows that more than half of the respondents have committed a laboratory error themselves or have observed other laboratory staff commit errors majorly in pre- examination phase and examination phase. Concerning the results of the present study, there is failure to follow established guidelines by the personnel possibly due to sub-optimal administrative control. In contrast to our study, Audu et al³ reported that following re-training the staff of their laboratory showed improvement in pre- analytical and post- analytical examination and less improvement in analytical phase. This might be due to the continuous laboratory education on stakeholders involved in laboratory testing.
Our study findings showed that more than half of the laboratory personnel complained of inappropriately filled request forms by clinicians; with patient’s medical history being the most frequently neglected, followed by time/date of specimen collection. This is in contrast with a study done at Stellenbosch University by Zemlin et al¹⁴, which showed that medical details with a patient were most frequently neglected (74.5%), followed by clinicians contact details (65.2%), and 20.8% had no diagnosis. They reported that patient history was filled in from their study site, which they attributed to the fact that most of their laboratory request forms being pre- stamped with clinic details and the use of patient identity stickers.
The study findings show that almost all the clinicians have received wrong results from the laboratories, although greater than two thirds of them feel that laboratory results are necessary for patient management. This is a worrisome finding in a Tertiary Health Center of Excellence. All effort must be directed toward ensuring that the quality results are generated from the clinical laboratories in the view of their value in patient management. Tuijn et al in Northern Tanzania reported that only 33.3% clinicians use the test results that are provided with as against our study findings [15]. They attributed their unreliable results to lack of a highly-educated laboratory technician to perform tests, paucity of equipment’s and expired/lack of reagents.
Our study findings show that all the six aspects in client satisfaction for the four laboratories were rated excellent to good. This is in contrast with a study in Western Ethiopia where 62% were satisfied, 8% dissatisfied and 30% were neutral. The observable differences might be due to fewer number of health professionals approached in this study [16]. The study also shows that there is good perception for three laboratories; except for the medical microbiology laboratory, which was rated with poor perception. Finally, in the overall satisfaction for all aspect of laboratory services, more than half of the clients were dissatisfied. This may be attributable to poor communication and feedback between the clinicians and the laboratorians. This was similar to the study by Tuijn et al. in Tanzania where they showed that the lack of communication between the laboratory staff and clinicians lead to poor satisfaction and the clinicians’ doubts about laboratory test results [15].
Conclusions
The study demonstrated that only few laboratory personnel in the tertiary health institution received in-service training on laboratory quality management. Laboratory errors occured and most prevalent errors committed were at pre-analytical and analytical phases. The most of the results churned out from these laboratories may not be accurate and thus may mislead the clinicians in patient diagnosis and management. All of the four laboratories neither have quality control team nor a person designated as quality manager. In line with these findings, it is recommended that laboratories should be strengthened in line with the WHO/AFRO initiative. This is in addition to regular training/re-training of laboratory staff and enhanced communication between the clinicians and the laboratory personnel.
Conflict of Interest
The authors hereby declare that there is neither competing interest in the outcome of the study nor conflict of interest in the conduct and publication of this research work.
Acknowledgement
We thank all the staff and management of the tertiary Hospital for their cooperation in conducting this study.
 
References