Clin Chem Lab Med 2020; 58(10): 1655–1662
Alexander von Meyer*, Giuseppe Lippi, Ana-Maria Simundic and Janne Cadamuro
Exact time of venous blood sample collection – an unresolved
issue, on behalf of the European Federation for Clinical Chemistry
and Laboratory Medicine (EFLM) Working Group for Preanalytical
Phase (WG-PRE)
https://doi.org/10.1515/cclm-2020-0273
Received March 7, 2020; accepted April 27, 2020
Abstract
Objectives: An accurate knowledge of blood collection
times is crucial for verifying the stability of laboratory
analytes. We therefore aimed to (i) assess if and how
this information is collected throughout Europe and (ii)
provide a list of potentially available solutions.
Methods: A survey was issued by the European Fed-
eration of Clinical Chemistry and Laboratory Medicine
(EFLM) Working Group on Preanalytical Phase (WG-PRE)
in 2017, aiming to collect data on preanalytical process
management, including sampling time documentation, in
European laboratories. A preceding pilot survey was dis-
seminated in Austria in 2016. Additionally, preanalytical
experts were surveyed on their local setting on this topic.
Finally, the current scientific literature was reviewed on
established possibilities of sampling time collection.
Results: A total number of 85 responses was collected
from the pilot survey, whilst 1347 responses from 37 Euro-
pean countries were obtained from the final survey. A
minority (i.e. ~13%) of responders to the latter declared
they are unaware of the exact sampling time. The corre-
sponding rate in Austria was ~70% in the pilot and ~30%
in the final survey, respectively. Answers from 17 preana-
lytical experts from 16 countries revealed that sampling
time collection seems to be better documented for out-
than for in-patients. Eight different solutions for sample
time documentation are presented.
*Corresponding author: Alexander von Meyer, Institute for Laboratory
Medicine and Microbiology, Munich Municipal Clinic Group, Munich,
Germany, Phone: +49-179-2940459,
E-mail: alexander.meyer@muenchen-klinik.de
Giuseppe Lippi: Section of Clinical Biochemistry, University of
Verona, Verona, Italy
Ana-Maria Simundic: Department for Medical Laboratory
Diagnostics, Clinical Hospital “Sveti Duh”, Zagreb, Croatia; and
Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb,
Croatia
Janne Cadamuro: Department of Laboratory Medicine, Paracelsus
Medical University, Salzburg, Austria. https://orcid.org/0000-0002-
6200-9831
Published online June 05, 2020
Conclusions: The sample collection time seems to be
documented very heterogeneously across Europe, or not
at all. Here we provide some solutions to this issue and
believe that laboratories should urgently aim to imple-
ment one of these.
Keywords: blood sampling; sampling time.
Introduction
The quality of pre- and post-analytical phases in laboratory
medicine is, amongst other aspects, guaranteed by main-
taining specified time intervals, such as the maximum
allowable period between sample collection and centrifu-
gation (when needed) or analysis, duration of transporta-
tion, storage time and so forth. An accurate definition of
these time intervals is crucial for assuring the analytical
stability of biospecimens, providing information allowing
the laboratory staff to determine how much the result has
varied from the true value and whether this bias is analyti-
cally or clinically acceptable. National and international
standards mandate most laboratories to track the sample
journey, including the time interval between collection
and first check-in in the laboratory [1]. The application of
accurate storage limits after analysis is also necessary for
preventing deterioration of many analytes in biological
samples. Many approaches are already existing or under-
way for this purpose. Moreover, some regularly updated
databases have been established on sample stability [2, 3].
The European Federation of Clinical Chemistry and Labo-
ratory Medicine (EFLM) Working Group on Preanalytical
Phase (WG-PRE) is also currently establishing a stand-
ardized checklist for stability studies in order to make
data comparable [4]. This information is necessary in all
modern laboratory services, for comparing local practices
of sample handing with clearly established limits.
Ideally, tracking a sample journey requires collec-
tion of accurate information on the time elapsed between
collection of samples and their delivery to the testing
point or the point of stabilization, which is very often a
centralized clinical laboratory. The time of delivery can
be easily monitored, as sample check-in timepoints are
1656 von Meyer et al.: Exact time of venous blood sample collection

recorded by the vast majority of laboratory information Table 1: Results from EFLM Pilot-Survey among Austrian laboratories.
systems (LISs). However, there is widespread perception
that the quality of information on sample collection time, n %

provided by the staff in charge of ordering the test and/
or drawing blood, may be largely unreliable [5, 6]. This is
of outmost significance if one considers that the stability
of many analytes can only be safely guaranteed when all
respective timepoints are monitored. The current scien-
tific literature emphasizes that accurate registration of
collection time is necessary for deciding as to whether
some tests shall be performed or not (e.g. plasma glucose,
hormones, therapeutic drug monitoring). Many test refer-
ence intervals, as well as results of therapeutic drug moni-
toring, are strongly dependent on the sampling time [5,
7–9]. Therefore, major efforts should be made to improve
the quality of this information, thus developing reliable
tools for improving current practices, especially in those
centers where this aspect may be partly (or completely)
overlooked or underestimated. Hence, this study is aimed
to present the unpublished part of the results of a previous
EFLM survey [10, 11], and provide an overview and discus-
sion on possible solutions to better address the issue of
sampling time registration.
Materials and methods
The results discussed in this paper are a part of a larger survey, car-
ried out by the EFLM WG-PRE between October 1st and November
30th 2017 [10, 11]. The study aimed to investigate how European labo-
ratories are currently dealing with preanalytical sampling handling
in general, as well as with hemolysis, icterus and lipemia interfer-
ence, in particular.
Before widespread dissemination across European laborato-
ries, the survey was piloted in Austria from March 9th until April
17th, 2016. The pilot survey was disseminated among 359 Austrian
laboratories by the national external quality assessment (EQA) pro-
vider (ÖQUASTA), using an online survey tool (Surveymonkey, San
Mateo, CA, USA). Results of this survey were not published, as they
only served as a basis for defining a final European survey. Among
Yes 19 22.4
Partly 6 7.1
No (e.g. only the time of order placement is provided) 59 69.4
No samples sent from external sources 1 1.2
Total 85
other interrogations regarding preanalytical topics, this pilot survey
contained the following question: “Do you know when blood was
collected?” (answer options were “Yes”, “No” and “Other”). Free text
responses to the option “other” were categorized.
Based on these answers, the corresponding question in the final
EFLM survey was modified as follows: “Are the exact date and time
of blood collection provided with the sample?” (answers options
were “Yes, for all samples”, “Yes, for most samples”, “Yes, for some
samples”, “No (e.g. only the time of order placement is provided)”
and “We do not collect blood from in-/out-patients”). Answers had to
be provided for both inpatients and outpatients (including primary
care) separately, when appropriate (matrix question). Answers were
evaluated overall as well as country specific, using IBM SPSS Statis-
tics V.24 (IBM, Armonk, NY, USA).
To obtain further information on this matter in different Euro-
pean countries, another brief survey was disseminated by email
in January 2019 among the national representatives of the EFLM
WG-PRE and some expert consultants of this Working group (WG).
All the members of this WG are experts on preanalytical issues and
therefore qualified to provide professional feedback on this specific
topic. The survey was carried out as an open question, asking for
brief description on sampling time registration and documentation
at their local facilities. All free text answers were summarized in a
table for comparing the different situation (Tables 1 and 2). In- and
outpatients were separated, thus avoiding biases due to differences
in operational processes between these collectives. In a hospital set-
ting often two different forms of organization exist, collection by spe-
cialized phlebotomist or sampling by general nurses or doctors. Both
situations can exist in the same hospital and are therefore assessed
separately. After the responses were analyzed and incorporated into
an explanatory table, the draft was sent back to participants, so that
they could approve the trueness and correctness in interpretation of
the free text answers.

Table 2: Results from EFLM Survey among 37 European countries.

All participants Austrian participants

In-patients Out-patients In-patients Out-patients

n % n % n % n %

Yes, for all samples 654 48.6 488 36.2 26 38.8 16 23.9
Yes, for most samples 349 25.9 437 32.4 13 19.4 12 17.9
Yes, for some samples 108 8.0 149 11.1 6 9.0 11 16.4
No (e.g. only the time of order placement is provided) 169 12.5 187 13.9 20 29.9 20 29.9
We don’t serve in/out-patients 67 5.0 86 6.4 2 3.0 8 11.9
Total 1347 1347 67 97.0 67 88.1
 von Meyer et al.: Exact time of venous blood sample collection 1657

Aiming to provide information on possible methods of sam-
pling time documentation, including their benefits, limitations and
requirements, all authors reviewed current literature, manufacturer
information or collected information from personal experience or
experiences from colleagues and bundled results in a structured
manner.
laboratories which did not handle blood samples or from
non-EFLM member states, 1347 responses from 37 Euro-
pean countries were further evaluated. All participants
answered the question concerning sampling time, 67 of
which were from Austria.
The main results of the EFLM survey on collection time
are shown in Table 2. About 70% of participating laborato-

Results
Pilot survey carried out in Austria in 2016
A total of 101/359 replies (response rate, 28.1%) were
received, 88 of which answered to the question on time of
blood collection. Three answers were left blank and had to
be excluded. Replies of the remaining 85 answers regard-
ing the time of blood collection are shown in Table 1.
ries of the pilot study stated that they are not informed on
the exact blood collection time upon receiving samples.
This number decreased to approximately 30% when Aus-
trian responders answered the respective question on the
final European survey.
Results of survey among WG-PRE members in
2018

Overall, 17 preanalytical experts of 16 different coun-

Results of EFLM survey in 2017 tries provided detailed information on their healthcare
setting concerning sampling time of in- and outpa-
A total number of 1416 responses from 45 different coun- tients for their health care setting. Results are shown in
tries could be collected. After eliminating responses from Table 3.

Table 3: Results from survey among EFLM WG-PRE members.

Country Inpatients Outpatients

Phlebotomist Other staff All staff

Special Documentation Time Special Documentation Time Special Documentation Time

device in HIS/LIS/ quality device in HIS/LIS/ quality device in HIS/LIS/ quality
Ordering system Ordering system Ordering system

Germany No Variable Bad No Variablea Bad n/a n/a n/a

Austria n/a n/a n/a No No Bad no Good Good
Italy n/a n/a n/a No Variable Bad yes Excellent Excellent
Croatia n/a n/a n/a No Variable Bad Yes Good Good
Spain no no bad No No Bad No No Bad
Spain [2] n/a n/a n/a No Variable Bad No Variable Variableb
UK No Good Good No Variable Variable No Variable Bad
Denmark Yes Excellent Excellent No Variablea Good No Good Good
Sweden No Excellent Excellent No Excellent Excellent No Excellent Excellent
Turkey n/a n/a n/a Yes Excellent Good Yes Excellent Good
Belgium n/a n/a n/a No Good Good No Excellent Excellent
Russia No No Bad No Variable Bad No Good Good
US No Excellent Excellent No Good Variable No Excellent Excellent
Portugal n/a n/a n/a No Variablea Good Yes Excellent Good
Serbia n/a n/a n/a No No Bad No Good Good
Ireland No Good Good No Good Good No No Bad
Norway No Excellent Good No Excellent Good No Good Good

Personal experience of the WG-PRE members in their own hospitals. Special device: Are solutions other than paper-based or CPOE systems
used?; Documentation in hospital information system (HIS)/laboratory information system (LIS): Rating of the functionality to communicate
sampling time; Rating categories were: no (functionality not available); variable (available at some sites); good (available almost
everywhere) and excellent (everywhere available). Time quality: Rating of the documentation quality; Rating categories were: bad; variable;
good and excellent. aOften pre-entered, meaning written a priori in the LIS, but not necessarily adjusted according to the actual time of
sampling; bhospital unit – perfect, primary care unit – weak.
1658 von Meyer et al.: Exact time of venous blood sample collection
Discussion
According to the results of our surveys, documentation on
accurate sampling time appears to be handled rather het-
erogeneously throughout Europe, and shall still be con-
sidered an unresolved issue.
Interpreting data of the final EFLM-survey could lead
to the conclusion that the overall quality of sampling time
is very acceptable, because almost 87% participants for
inpatients and 85% for outpatients reported that they can
provide traceability of sampling time with good documen-
tation at least for some samples. These results may seri-
ously be questioned considering the following aspects.
The country-specific evaluation for Austrian partici-
pants of the final European survey only shows slightly
lower results (69% for inpatients and 66% for outpatients,
respectively) compared to the above-mentioned overall
results from European responders. However, results from
the Austrian pilot study, distributed among the same col-
lective with a comparable number of participants (85 pilot
study/65 final study), revealed a far lower number of 29%
of responders who stated sufficient sampling time quality
for all or most samples. This difference reflects the weak-
ness of surveys in general as these findings suggest biased
results due to a kind of expectancy bias or peer pressure
leading participants to respond in a way they think is
appropriate, or due to misinterpreting the question.
This impression is reconfirmed by EFLM WG-PRE
experts, which report a low number of exact sampling
time documentation in their health care setting (answers
in Tables 1 and 2 “excellent quality” for “inpatients/other
staff” 6% and “outpatients” 25%). Additionally, unlike the
finding of the final EFLM questionnaire, the survey among
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
573 61 237 18 204 262
0%
15189
17025
9001
22870
National
No accr/cert
In-patients
Figure 1: EFLM survey – Answers to the question “Are the exact date and time of blood collection provided with the sample?” in regards to
the accreditation/certification status of the responding laboratory.
Numbers in white at the bottom of the columns represent the total number of responses.
the experts shows a substantial better quality of sampling
time information for outpatients compared to inpatients.
Potential reasons include the fact that blood from outpa-
tients is usually drawn shortly after the request for labora-
tory tests is made, or that blood collection for outpatients
is performed by laboratory staff in many facilities. Unlike
this situation, laboratory requests for inpatients are
usually placed in advance, stating an assumed time of
blood collection, which does not always correspond to
the exact time of drawing blood. Moreover, blood collec-
tion is mostly carried out by non-laboratory staff in clini-
cal wards, who sometimes tend to have lower education
and training on good phlebotomy practice, thus lacking
the knowledge of poor sample time documentation on
analytical quality. This rational is also supported by the
difference in documentation quality between phleboto-
mist and “other staff” sampling in the inpatient setting
(Answer “excellent” in Tables 1 and 2 “inpatients/phlebot-
omists” 33% versus “inpatients/other staff” 6%). Another
aspect for a higher documentation quality in outpatients
is that technical devices, such as mobile handhelds, or
stationary hardwired apparatus are expensive and are not
available in all phlebotomy settings. The survey among
national WG-PRE representatives shows a few outpatients
sampling sites equipped with these technical devices.
Another interesting finding was the fact that 45%–
64% of laboratories which stated to be accredited accord-
ing to the ISO 15189 regulation do not have information on
all sampling time data, although this guideline demands
it [1] (Figure 1).
Considering the high clinical importance of knowing
the exact sampling time in order to correctly interpret the
stability of specific analytes, addressing correct reference
No
Yes, for some samples
Yes, for most samples
Yes, for all samples
77 568 63 225 17 205 252 80
Other
15189
17025
9001
22870
National
No accr/cert
Other
Out-patients
 von Meyer et al.: Exact time of venous blood sample collection 1659

ranges for analytes with a high circadian rhythm or to
calculate the correct total turnaround time (TAT), it is dis-
appointing that very little emphasis has been put on this
issue in the past. Despite overwhelming evidence on the
impact of durations from blood collection to sample anal-
ysis in current literature [12–15], scarce information can be
found on if and how sampling time is assessed.
As a limitation of this study, we want to mention that
the WG-PRE experts have only described the situation in
their local laboratories and specific healthcare environ-
ment, so that the scenario may not be ideally representa-
tive of their entire country. Therefore, our finding only
represent an approximation of the situation at the time of
the survey.
Possible solutions
Recognizing the actual situation in most European labo-
ratories as improvable concerning the documentation of
sampling time, it is important to discuss which solutions
for documentation are already available and can be
implemented.
A structured overview of existing and future solutions
should motivate laboratory representatives to focus on
improving this important issue. As current evidence on
this neglected issue is scarce, possible advantages and
disadvantages are reported from the authors’ point of
view. A structured overview is presented in Table 4.
Paper-based request
Probably the easiest, but least valuable, means of track-
ing blood collection times entails paper-based request-
ing, where the collecting staff member has to provide
clear, written information. From personal experiences of
the authors, respective compliance in filling out respec-
tive fields for the time of sampling is low. Therefore, this
method will most likely lead to poor sample time quality
at best. Additionally, this method bares potential errors of
illegibility and transcription.

Table 4: Possible solutions for documenting correct sampling times.

Requirements Advantages Limitation/disadvantages

Paper-based request Appropriate paper forms Easily available Low compliance in entering correct
carriers (staff available Easy to use sampling times
to carry papers) Independent from electricity, Illegibility/transcription errors
power supply, IT system downtime Manual entry of sampling time with
respective source of uncertainty
Need of regular paper forms supply
Computerized HIS-, LIS-interface Easily available Low compliance in entering correct
physician order entry Electronic documentation of sampling times
system (CPOE) sampling time Manual entry of sampling time with
respective source of uncertainty
Handheld ID device Continuous WiFi access Automated documentation of Cost intensive
sampling time (one time investment)
Automatic tube LIS-interface Automated documentation of Cost intensive
labeling system sampling time (one time investment)
Pre-labeled LIS-interface dedicated Automated documentation of Extra costs
barcodes-tubes devices continuous WiFi sampling time (continuous investment) Changes in
access Simplification and standardization laboratory organization
of phlebotomy process No written patient information on the tubes
(only barcode)
Smart rack based LIS-interface Automated documentation of Cost intensive
technology sampling time (one time investment)
Extended point of LIS-connected POC- Automated documentation of Modified POC-LIS interface/currently not
care blood sugar devices sampling time available
devices Devices already in use
Low to medium costsa
Phlebotomist Human resources Easy to train correct sampling Cost intensive
Adapt to special situations (continuous investment)

POC, point of care; LIS, laboratory information system; HIS, hospital information system; aDepending on the local setting and availability
and distribution of respective POC devices including network connections.
1660 von Meyer et al.: Exact time of venous blood sample collection
Computerized physician order entry (CPOE) system
A similar solution is the use of an LIS with functionality
of computerized physician order entry (CPOE) extension
or interface to an external CPOE. This system, although
electronic, has the same drawbacks as the paper based
version, namely the low compliance of users to conse-
quently enter correct sampling times. Even if this entry is
made mandatory, orders are often registered long before
blood is collected, especially for inpatients, making
respective timestamps unreliable.
The usually available options in clinical settings all
over Europe are these first two (paper based request forms
and CPOE). Both systems provide a heterogeneous quality
for sampling time. If just a few people do work with the
system, for example, in an outpatient clinic, it is possible
to achieve satisfactory documentation quality. Neverthe-
less, the quality obviously drops in settings where more
people are involved. The advantages of these solutions are
the low costs and the availability on every computer. From
our survey, we can see that these systems are widespread
all over Europe.
Single (extra) handheld device
For documentation of sampling time and other clinically
important information related to the sampling process,
some health care settings have implemented dedicated
devices [16, 17], or based on smartphones or tablets,
equipped with specific, usually in-house developed
software (app) for the purpose of simplifying the admin-
istrative part of blood collections including timepoint
documentations.
The fact that these devices are only dedicated to phle-
botomy procedures without any conflict with other clini-
cal processes bears many potential advantages such as
respective software focusing solely on issues like identi-
fication of sample collector, minimization of patient misi-
dentification, phlebotomist guidance throughout sample
collection process and so forth. Although some of these
solutions are already commercially available in some
countries, the additional costs for hardware and software
are often exceeding local budgets.
Automatic tube labeling system
Another solution, especially for outpatient wards, encom-
passes the use of automated tube labeling systems [18].
These devices are designed to improve automation in
test requests, patient identification, tube and container
specimen selection, labeling and check out, with a com-
plete traceability of the process, including time stamping.
Hence, such instruments may aid in phlebotomist guid-
ance throughout the sample collection process, recogni-
tion of blood tubes by cap color, optimizing label position
on tube, minimizing preanalytical errors such as patient
misidentification and others. Most importantly, time
stamps are collected and documented into the hospital
information system (HIS/LIS) via a two-way online inter-
face, one of the requirements of this system, apart from
a continuous power supply. When other blood collection
tubes come into use or the tube lot changes, an instrument
re-calibration for color recognition might be necessary. As
implantation of such instruments on all wards of a hos-
pital would be financially unsustainable, they are mostly
used in outpatient wards or phlebotomy centers with high
patient throughput.
Pre-labeled barcodes-tubes
Apart from blood sampling tubes with blank or no label,
so-called “pre-barcoded” tubes are available from some
vendors [19]. The barcode incorporates a unique alpha-
numeric code, especially produced for specific custom-
ers. Orders are only registered in the order entry system,
without printing labels. During the sampling process, the
patient (wristband) and the pre-barcoded collection tubes
are scanned, so that the blood collection time is automati-
cally tracked. Subsequently, the combination of patient
and sample information is transferred to the LIS for further
processing. As LISs usually produce the sample barcode
in their own system, this process is combined with bigger
change in LIS or comprehensive new interfaces. An imple-
mentation of this system requires dedicated devices for
barcode scanning and, if used as non-stationary, continu-
ous WiFi access for data transfer. The missing patient data
on the tube may have advantages in terms of data security
and disadvantages in terms of archiving. It surely helps in
improving patient misidentification errors and simplifying
phlebotomy processes, as no additional barcode printer is
necessary. Similar to the above-mentioned solutions, extra
costs for dedicated devices as well as the slightly higher
costs for these special tubes compared to those without
label have to be considered. In clinical settings where
these system are implemented, mainly positive effects on
some preanalytical quality indicators were reported [20].
However, overriding the automatically set sampling time
or manual entry shall be enabled in certain circumstances
(e.g. loss of network connection, device malfunction, etc.).
 von Meyer et al.: Exact time of venous blood sample collection
Smart rack-based technology
In many clinical settings a complete supply with network
connectivity including WiFi Access is not available. In
these situations, a technology supporting all sampling
information to be transported accompanying the sample
to the laboratory is an advantage. The so-called “smart
rack” technology fulfills these requirements [21]. Directly
after sampling, all collected tubes as well as the patient
and the phlebotomist are identified by scanning respec-
tive barcodes (e.g. patient wristband). Gathered informa-
tion is stored on the radio frequency identification (RFID)
tacks of the rack and the tubes are put in a given position
in the rack. When samples are registered in the labora-
tory, the rack information is automatically transferred to
the LIS. For this last step, an interface between the smart
rack server and the LIS is necessary. At the sampling site
a power supply for scanning and RFID writing devices is
required. Comparable to other solutions, minimization of
preanalytical errors, like patient misidentification, is also
achievable with this technique. Additional monitoring of
transport temperature between two laboratories may be
achieved by using especially equipped transport boxes.
Preanalytically affected tubes, for example, due to pro-
longed transport time or wrong transport temperature or
even missing tubes can be easily identified at sample recep-
tion. Monitoring and statistic evaluation of preanalytical
parameter can be done based on the acquired information.
Costs for the system itself, the smart racks, all sampling
devices and potential temperature-monitoring-boxes need
to be considered before implementation of this solution.
Point-of-care (POC) blood sugar devices
Most of the afore-mentioned solutions require some sort of
financial investment. The results of the survey presented
in this article highlight that economic issues are one of the
main reasons for the lack of better solutions so far. In many
European clinical environments, POC test (POCT) glucose
measuring devices are already implemented including a
local area network (LAN) or wireless-LAN (WLAN) connec-
tion to the local network. An interface to the LIS for trans-
ferring patient test results is also often available. These
existing connections could be used for implementing a
new functionality for these devices. Adaption of software
and slightly modified interface between POC device and
LIS would be necessary to extend the actual functionality,
transforming it into a scanning device for routine blood
collections. The functionality in the sampling process
could be comparable to the afore-mentioned single
1661
handheld devices, but without extra costs. Additional
costs could, however, emerge if additional network con-
nections or devices are needed, depending on the local
setting.
Ongoing discussions with vendors of these devices
spark the hope that the necessary software extensions
could be available soon. Depending on the software
change and the existing communication between device
and LIS (unidirectional or bidirectional), further support
of the sampling process could hence be predictable. For
future tenders of POC glucometers, extension of a corre-
sponding functionality could be considered.
Phlebotomist
In the USA, phlebotomist as specialists in blood collec-
tion are widely established (http://www.phlebotomy.
org/). In Europe, this profession is still rarely seen (e.g.
in the UK) in most countries, as a survey carried out by
the WG-PRE throughout 28 European countries shows
[22]. This finding could be confirmed by our survey among
preanalytical experts. These results also show that collec-
tion time is better documented when blood is collected
by phlebotomists. In order to establish this allocation of
blood sampling, human resources, ideally assigned to
the laboratory and only dedicated to the task of phlebot-
omy, are required. Once established, this new unit needs
specialized training and re-training to sustain sampling
quality. Comparable to other processes, the quality in the
blood collection process may improve by involving fewer
and better educated employees. Such initiatives may also
generate better communication between professions and
lead to better understanding of nurses and clinicians
on the impact of preanalytical errors on laboratory test
results. High cost, addressed as additional personnel, is
an often-heard limitation of phlebotomist’s implementa-
tion. However, these resources may be acquired by simply
re-distributing phlebotomy tasks from nurses or other
personnel. Additionally, when considering all secondary
costs that may be reduced by implementation of phleboto-
mists (e.g. reduction in repeated blood sampling), such
interventions may even be cost-neutral.
Conclusions
The sampling time is a necessary and valuable informa-
tion in laboratory medicine. As many formal processes
such as accreditation do actually request this task, many
1662 von Meyer et al.: Exact time of venous blood sample collection
laboratories throughout Europe are challenged in provid-
ing high quality documentation. Even if this a universal
requirement in laboratory medicine, the actual situation
all over Europe shows a lack of acceptable documenta-
tion quality. There are already some solutions available,
which provide higher quality than paper-based or elec-
tronic CPOE-based solutions. These innovative strategies
have not reached widespread popularity so far, mainly
due to their relevant costs. High quality solutions, such as
assessment with already implemented devices like POCT-
glucometers, could help improving the current situation,
but are also not available everywhere so far.
Acknowledgments: We want to thank Dr. Christoph Buchta
for aiding in the distribution of the Austrian pilot survey.
Author contributions: All authors have accepted respon-
sibility for the entire content of this manuscript and
approved its submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: Authors state no conflict of interest.
References
1. DIN/EN/ISO 15189:2012. Medical laboratories – Requirements
for quality and competence. Geneva, Switzerland: International
Organization for Standardization, 2012.
2. Guder W, Fiedler GM, da Fonseca-Wollheim F, Schmitt Y, Töpfer
G, Wisser H, et al. Quality of diagnostic samples, 4th ed. Becton
Dickinson, Oxford, UK: DGKL, 2015.
3. Gomez Rioja R, Martinez Espartosa D, Segovia M, Ibarz M, Llopis
MA, Bauca JM, et al. Laboratory sample stability. Is it possible to
define a consensus stability function? An example of five blood
magnitudes. Clin Chem Lab Med 2018;56:1806–18.
4. Cornes M, Simundic AM, Cadamuro J, Costelloe S, Baird G, Kris-
tensen G, et al. The CRESS checklist for reporting stability stud-
ies: on behalf of the European Federation of Clinical Chemistry
and Laboratory Medicine (EFLM) Working Group for the Preana-
lytical Phase (WG-PRE). in print.
5. Hawkins RC. Laboratory turnaround time. Clin Biochem Rev
2007;28:179–94.
6. Lippi G, Betsou F, Cadamuro J, Cornes M, Fleischhacker M,
Fruekilde P, et al. Preanalytical challenges – time for solutions.
Clin Chem Lab Med 2019;57:974–81.
7. Jakobsen MI, Larsen JR, Svensson CK, Johansen SS, Lin-
net K, Nielsen J, et al. The significance of sampling time in
therapeutic drug monitoring of clozapine. Acta Psychiatr Scand
2017;135:159–69.
8. Doki K, Shirayama Y, Sekiguchi Y, Aonuma K, Kohda Y,
Homma M. Optimal sampling time and clinical implication of
the SCN5A promoter haplotype in propafenone therapeutic drug
monitoring. Eur J Clin Pharmacol 2018;74:1273–9.
9. Jia Y, Meng X, Li Y, Xu C, Zeng W, Jiao Y, et al. Optimal sampling
time-point for cyclosporin A concentration monitoring in heart
transplant recipients. Exp Ther Med 2018;16:4265–70.
10. Cadamuro J, Cornes M, Simundic A-M, de la Salle B, Kristensen
GB, Guimaraes JT, et al. European survey on preanalytical sample
handling – Part 1: how do European laboratories monitor the pre-
analytical phase? On behalf of the European Federation of Clini-
cal Chemistry and Laboratory Medicine (EFLM) Working Group for
the Preanalytical Pha. Biochem Med (Zagreb) 2019;29:322–33.
11. Cadamuro J, Lippi G, von Meyer A, Ibarz M, van Dongen E,
Lases, et al. European survey on preanalytical sample handling
– Part 2: practices of European laboratories on monitoring and
processing haemolytic, icteric and lipemic samples. On behalf
of the European Federation of Clinical Chemistry and Laboratory
Medicine (EFLM) Working Group for the Preanalytical Phase (WG-
PRE). Biochem Med (Zagreb) 2019;29:020705.
12. Boyanton Jr BL, Blick KE. Stability studies of twenty-four ana-
lytes in human plasma and serum. Clin Chem 2002;48:2242–7.
13. Dupuy AM, Cristol JP, Vincent B, Bargnoux AS, Mendes M, Phi-
libert P, et al. Stability of routine biochemical analytes in whole
blood and plasma/serum: focus on potassium stability from
lithium heparin. Clin Chem Lab Med 2018;56:413–21.
14. Henriksen LO, Faber NR, Moller MF, Nexo E, Hansen AB. Stability
of 35 biochemical and immunological routine tests after 10 h
storage and transport of human whole blood at 21 degrees C.
Scand J Clin Lab Invest 2014;74:603–10.
15. Oddoze C, Lombard E, Portugal H. Stability study of 81 analytes
in human whole blood, in serum and in plasma. Clin Biochem
2012;45:464–9.
16. Iatric – Barcode Specimen Collection with MobiLab®. https://
new.iatric.com/barcode-specimen-collection-handheld-phlebot-
omy (Accessed: 31.3.2020).
17. Smart 4 Diagnostics. https://smart4diagnostics.com/
(Accessed: 31.3.2020).
18. Piva E, Tosato F, Plebani M. Pre-analytical phase: the automated
ProTube device supports quality assurance in the phlebotomy
process. Clin Chim Acta 2015;451:287–91.
19. Greiner Bio-One. VACUETTE Barcode Tubes. https://www.gbo.
com/fileadmin/user_upload/Downloads/Brochures/Brochures_
Preanalytics/English/980289_BarcodeRoehrchenbroschuere_e_
rev00_0912_lowres.pdf (Accessed: 18th Nov. 2019).
20. Barak M, Jaschek R. A new and effective way for preventing pre-
analytical laboratory errors. Clin Chem Lab Med 2014;52:e5–8.
21. Maksense – I Rack. https://maksense.com/maksense/irack
(Accessed: 31.3.2020).
22. Simundic AM, Cornes M, Grankvist K, Lippi G, Nybo M, Kovalevs-
kaya S, et al. Survey of national guidelines, education and train-
ing on phlebotomy in 28 European countries: an original report
by the European Federation of Clinical Chemistry and Laboratory
Medicine (EFLM) working group for the preanalytical phase (WG-
PA). Clin Chem Lab Med 2013;51:1585–93.