Liping Cui,1,* Wanling Li,1,2,* Yueqin Li,3 Xiaofang Feng,3 Yue Wang,4 Pei Gao4 

1Department of Nursing, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China; 2Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 3Department of General Medical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China; 4Nursing College, Shanxi Medical University, Taiyuan, 030032, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yueqin Li, Department of General Medical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99 Longcheng Street, Xiaodian District, Taiyuan, Shanxi, 030032, People’s Republic of China, Tel +86 0351-8368114, Email li_yueqin@163.com

Objective: This single-center, before-and-after study applied the structure–process–outcome (SPO) model to pre-analytical quality control to investigate its effect on laboratory testing quality, nursing practices, patient satisfaction, and clinician trust in test results.
Methods: A before-and-after design was conducted in a provincial Class A tertiary hospital. The control group (April–September 2022) and observation group (April–September 2023) each included all laboratory specimens and 550 clinical nurses (from the same wards). The SPO-guided pre-analytical quality management pathway involved forming a multidisciplinary team, establishing a grid management system, implementing a non-punitive reporting system, standardizing specimen collection, and developing a quality management information system. Groups were compared on non-compliant test sample rates, nurses’ knowledge, beliefs, and behaviors, operational standardization, patient satisfaction, and clinical doctors’ trust. Data were analyzed using t-tests (with effect sizes) and χ²-tests; confidence intervals and multiple-comparison corrections were also applied.
Results: The observation group showed significantly lower rates of non-compliance in sample type, collection container, volume, contaminated blood cultures, and coagulated samples (all p < 0.01, with 95% confidence intervals). Nurses’ knowledge (Cohen’s d = 0.44) and behaviors (Cohen’s d = 1.56) improved significantly. Operational standardization (92.5 ± 3.2 vs 85.7 ± 4.1), patient satisfaction (93.8% vs 87.2%), and clinical doctors’ trust (91.2% vs 84.5%) also increased significantly (p < 0.01).
Conclusion: The SPO-based pre-analytical quality management pathway significantly improved non-compliant sample rates, nurses’ knowledge and behavior, operational standardization, patient satisfaction, and clinical trust in test results. This approach may serve as a reference for other institutions aiming to enhance pre-analytical quality management.

Keywords: structure–process–outcome model, pre-analytical quality, management pathway, before-and-after study