Evaluation of Preanalytical Quality Indicators by Six Sigma and Pareto`s Principle

Abstract

Preanalytical steps are the major sources of error in clinical laboratory. The analytical errors can be corrected by quality control procedures but there is a need for stringent quality checks in preanalytical area as these processes are done outside the laboratory. Sigma value depicts the performance of laboratory and its quality measures. Hence in the present study six sigma and Pareto principle was applied to preanalytical quality indicators to evaluate the clinical biochemistry laboratory performance. This observational study was carried out for a period of 1 year from November 2015-2016. A total of 1,44,208 samples and 54,265 test requisition forms were screened for preanalytical errors like missing patient information, sample collection details in forms and hemolysed, lipemic, inappropriate, insufficient samples and total number of errors were calculated and converted into defects per million and sigma scale. Pareto`s chart was drawn using total number of errors and cumulative percentage. In 75% test requisition forms diagnosis was not mentioned and sigma value of 0.9 was obtained and for other errors like sample receiving time, stat and type of sample sigma values were 2.9, 2.6, and 2.8 respectively. For insufficient sample and improper ratio of blood to anticoagulant sigma value was 4.3. Pareto`s chart depicts out of 80% of errors in requisition forms, 20% is contributed by missing information like diagnosis. The development of quality indicators, application of six sigma and Pareto`s principle are quality measures by which not only preanalytical, the total testing process can be improved.

Practical application of Six Sigma management in analytical biochemistry processes in clinical settings

“…In mathematical fields, sigma is the symbol for standard deviation (SD) . Some studies have shown that sigma metrics can be applied to quantitatively evaluate errors or defects in testing projects in clinical laboratories, and the results are quantified as defects per million (DPMs) . The Six Sigma metric corresponds to 3.4 DPM opportunities in a clinical process.…”

“…The Six Sigma metric corresponds to 3.4 DPM opportunities in a clinical process. To date, sigma methodology has mainly been applied in pre‐analytical and analytical processes in clinical laboratories, focusing on the evaluation of biochemical and immunoassay tests …”

Practical application of Westgard Sigma rules with run size in analytical biochemistry processes in clinical settings

“…So far, the sigma methodology has mainly been applied in the evaluation of immunoassay and biochemical tests. 4,5 In this study, Westgard sigma rules with a run size management method were used to evaluate the detection performance of clinical test items in a biochemical laboratory with the objectives of improving the quality level of the clinical biochemical laboratory and reducing the risk to patients.…”

Pengaruh Sosialisasi Diagram Pareto terhadap Pengetahuan dan Minat Perawat dalam Pengelolaan Bahan Habis Pakai

“…Berdasarkan hasil penelitian yang dilakukan, responden berumur 35-40 tahun dan >40 tahun yang dikategorikan sebagai perawat memiliki pengetahuan yang kurang terkait pengelolaan bahan habis pakai, yang dapat dikategorikan sebagai umur yang sudah tidak lagi fokus terhadap berbagai pekerjaan yang menuntutnya. Menurut Kulkarni et al (2018) , pengetahuan dan minat perawat yang telah diberikan sosialisasi akan berpengaruh kepada pekerjaan, penggunaan alat medis yang prioritas, pembukuan yang lebih rapi, sehingga memberikan keuntungan finansial kepada rumah sakit.…”