DOI: http://dx.doi.org/10.18203/2349-3933.ijam20204520

Quality indicators in a hematology laboratory- a retrospective analysis

Akriti Kashyap, Gurpreet Kaur, Preeti Tripathi, Arijit Sen

Abstract


Background: Quality indicators are objective parameters which help to assess the effectiveness of the working system in any laboratory. Aim and objective were to study 7 common quality indicators in the hematology laboratory of a tertiary care centre.

Methods: It was a retrospective analysis over a period of two and a half years (Jul 2017- Dec 2019). The following 7 QIs were analysed- sample rejection rates, sample redo rates, routine turnaround time (TAT), critical reports and their TAT, corrected reports, staining quality assessment and concordance in EQAS programme. The QI rates were calculated on monthly (or as specified) basis and trends were analysed. P value <0.05 was considered significant.

Results: The final result showed average routine, urgent and critical turnaround time to be 6.5 hrs, 1.1 hrs and 3.4 hrs respectively. The other QIs were as follows - sample redo rates (3.8%), sample rejection rates (3.2%), corrected report rates (before validation– 8.5%, after validation- 1.2%) staining quality (unsatisfactory days rate- 4.5%), 98% corcordant performance in EQAS. Over the study period, a significant downward trend was noticed in TAT and sample rejection rates (p value=0.001 and 0.007 respectively). Number of monthly critical alerts showed an upward trend (p value=0.045) which could be attributed to increased awareness amongst lab staff. Redo rates showed no significant change in trend over study period.

Conclusions: Quality indicators help in self-assessment and self-improvement. Their continuous monitoring is mandatory to have a tight quality check system and better clientele satisfaction.


Keywords


Quality indicators, Sample rejection, Redo, Turnaround time, Critical tests

Full Text:

PDF

References


Institute of Medicine Committee to Design a Strategy for Quality Review and Assurance in Medicare. Medicare: A Strategy for Quality Assurance. Washington, DC: National Academies Press; 1990

Lundberg GD. Acting on significant laboratory results. J Americ Medic Assoc. 1981;245:1762-3.

Clinical and Laboratory Standards Institute. Application of a Quality Management System Model for Laboratory Services. 3rd ed. Wayne, PA: CLSI; 2004. Document GP26-A3.

Institute of Medicine Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000.

Shahangian S, Snyder SR. Laboratory medicine quality indicators: a review of the literature. Americ J Clinic Pathol. 2009;131(3):418-31.

Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations: effects on resource utilization. Americ J Clinic Pathol. 1993;269(3):379-83.

Valenstein PN, Sirota RL. Identification errors in pathology and laboratory medicine. Clin Lab Med. 2004;24:979-96

Dale JC, Novis DA. Outpatient phlebotomy success and reasons for specimen rejection. Arch Pathol Lab Med. 2002;126:416-9.

Howanitz PJ. Errors in laboratory medicine: practical lessons to improve patient safety. Arch Pathol Lab Med. 2005;129:1252-61

Steindel SJ, Jones BA. Routine outpatient laboratory test turnaround times and practice patterns: a College of American Pathologists Q-Probes study. Arch Pathol Lab Med. 2002;126:11-8.

Dighe AS, Rao A, Coakley AB, et al. Analysis of laboratory critical value reporting at a large academic medical center. Am J Clin Pathol. 2006;125:758-64.

Jenny RW, Jackson KY. Proficiency test performance as a predictor of accuracy of routine patient testing for theophylline. Clin Chem. 1993;39:76-81.

Novak RW. Do proficiency testing participants learn from their mistakes? Experience from the EXCEL throat culture module. Arch Pathol Lab Med. 2002;126:147-9.