How do I properly label a specimen from an emergency department?

Proper Specimen Labeling from the Emergency Department

All specimens collected in the emergency department must be labeled with at least two unique patient identifiers (such as patient name and medical record number or date of birth) plus the date and time of collection, using a label printer or barcode system rather than handwriting to ensure legibility and reduce human error. 1

Essential Labeling Requirements

Minimum Required Information

• Two unique institutional identifiers (e.g., patient name AND medical record number, or patient name AND date of birth) firmly affixed to the specimen container 1
• Date and time of collection to allow accurate interpretation and tracking 1
• Specific anatomic site with sufficient detail (e.g., "dog bite wound right forefinger" rather than simply "wound") 1
• Specimen type clearly indicated (e.g., tissue, fluid, aspirate, swab) 1, 2

Critical Labeling Practices

• Use a label printer or barcode system rather than handwriting to preserve legibility and minimize human errors 1, 3
• Apply labels directly to the specimen container itself, not just the transport bag, to prevent mix-ups if containers become separated 1
• Label specimens immediately at the bedside after collection, before leaving the patient's side, to prevent identification errors 3, 4
• Ensure labels are waterproof and can withstand storage conditions (including freezing temperatures if applicable) 1

Specimen-Specific Considerations

For Microbiology Specimens

• Include clinical information about the suspected infection or site (e.g., "suspected diabetic foot infection" or "post-surgical abscess") to guide laboratory processing 1
• Note if antibiotics were already administered prior to collection, as this significantly affects culture interpretation 1
• For anaerobic cultures, clearly mark the specimen as requiring anaerobic transport 2

For Blood Specimens

• Label each tube with patient identifiers, date, and time 1
• For blood cultures, label each bottle in the set and indicate anatomic collection site (e.g., "right antecubital" vs "left antecubital") 2
• Document temperature conditions if specimen was exposed to extreme heat or cold during transport 1

For Tissue/Surgical Specimens

• Include tumor location and characteristics if applicable (e.g., "contrast-enhancing portion" for brain tumors) 1
• Note sample number if multiple specimens from same site (e.g., "sample 1 of 3") 1
• Document any special handling requirements (e.g., "for frozen section," "sterile for culture") 1

Technology Implementation

Barcode Systems

Implementing barcode technology with bedside printers reduces mislabeling errors from 103 to 8 per year (P < .001), representing the most effective intervention for preventing specimen identification errors. 5

• Barcode systems enable positive patient identification at the point of collection 5, 6
• Handheld printers allow immediate label generation at the bedside, eliminating pre-printed label errors 7
• Systems should include independent double-entry verification for high-risk specimens 7

Quality Improvement Impact

• Standardized labeling protocols reduce specimen labeling events from 5.79 per 1000 cases to 3.53 per 1000 cases (P = .028) 3
• Mislabeled specimens—the most serious error type—decrease significantly with systematic interventions (P < .001) 4

Common Pitfalls to Avoid

• Never label specimens before collection or use pre-printed labels that could be applied to the wrong patient 3, 4
• Never accept unlabeled specimens for processing; these must be rejected and recollected 1, 4
• Avoid vague anatomic descriptions like "eye" or "wound" without specific location details 1
• Do not use handwritten labels when label printers or barcode systems are available, as this increases error rates 1, 3
• Never label only the transport bag; the specimen container itself must be labeled 1
• Avoid labeling specimens away from the patient, as this creates opportunity for mix-ups in busy emergency departments 3, 4

Transport Documentation

• Specimens requiring special temperature control (e.g., on ice, room temperature, frozen) should have this documented on the label 1
• Time-sensitive specimens should be clearly marked with collection time to ensure processing within required timeframes 1
• For specimens transported to external facilities, ensure labels meet both institutional and shipping requirements 1