Quality Indicators

Quality Indicator 1: Percent of dried blood spot specimens that were unacceptable due to improper collection and/or transport1, 2


Purpose: To identify the number of dried blood spot specimens that are improperly collected or transported resulting in an additional specimen collected from the newborn to be submitted to the lab, thereby requiring additional work for laboratory personnel to acquire an acceptable specimen.

a) Percent of unacceptable dried blood spot specimens due to improper collection1,2
b) Percent of unacceptable dried blood spot specimens due to improper transport1,2

Screening Data for Denominators: Number of dried blood spot specimens received at your state's newborn screening laboratory.3

Quick Tips 

  • Do not include improper time of collecetion in QI 1a. Improper collection is defined as any specimen that is unacceptable for testing due to collection errors. Examples include: 
    • Insufficient quality of blood (QNS) 
    • Clotting or smearing 
    • Contamination 
    • Inadequately filled circles 
    • Oversaturation or layering of blood 
    • Use of capillary tubes and scratching or abrading by capillary tube spotting 
    • Incomplete drying before shipping 
    • Specimens colleceted on expired DBS cards 
  • Improper transport (QI b) Includes: 
    • Any specimen received after the state-defined length of time from collection that deems a specimen unacceptable for testing 
    • Any specimen that is damaged in transport 
    • Specimens placed in an airtight or sealed plastic bag with or without a desiccant. 


  1. Unacceptable dried blood spot specimens excludes those collected in less than 24 hours [for example Neonatal Intensive Care unit (NICU) infants].
  2. Definitions for improper collection and improper transport can be found in Appendix A: Glossary of Terms, at the end of the QI Source Document. If it is unknown whether unacceptable specimens were due to either improper collection or transport, they should be counted under improper collection only.
  3. This includes multiple specimens collected from a single newborn, but not monitoring specimens (e.g. PKU monitoring).