How do we use the data from pre-analytical quality indicators and how should we?

Abstract

It is impossible to imagine a modern medical laboratory without a structured quality management system in place. Nevertheless, this system usually focuses mostly on the analytical part of the total testing process (TTP), despite being aware of the fact that most errors occur in the pre-and post-analytical phases. There are many reasons possibly explaining this fact, one of them being that extra-analytical processes are hard to grasp, since they occur mostly outside of the laboratory and include many different parties. Despite these obstacles, it is mandatory to keep all steps of TTP, potentially influencing the analytical test result or their interpretation, under meticulous quality control and to improve them as much as possible, involving all health care workers contributing to sample quality. Additionally, it is necessary to collect and evaluate all data in a standardized manner, not only within one laboratory, but nationwide and internationally. This is a perquisite for valid data comparison over time (trend analysis) and benchmarking, the basis for threshold definition and continuous improvement. A widely accepted method to meet all these requirements is the concept of quality indicators (QIs). In this review, we provide an overview over this topic and we discuss an easy to use and freely available tool, aiming to aid laboratories in data collection and comparison: The QIs project of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on "Laboratory errors and patient safety" (WG-LEPS). Additionally, we provide practical suggestions on how to successfully implement QIs within any laboratory.

European survey on preanalytical sample handling – Part 1: How do European laboratories monitor the preanalytical phase? On behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Pha

“…This enables laboratory professionals to contact the specific health care workers/wards/areas/locations needing attention and to develop ways of improving the situation ( 14 , 15 ). Tools to approach the problem are freely available when documentation within a LIS is not possible ( 16 - 18 ).…”

Managing inappropriate utilization of laboratory resources

“…-As you cannot improve what you do not measure, a monitoring system accompanying the chosen DM tool should be implemented. Appropriate quality indicators might be "requests per 1000 inhabitants" or "tests per request", and should be analyzed and discussed with clinicians on a regular basis [61][62][63][64]. -The implemented DM strategies need to be revised and updated on a regular basis, at least every year, always in agreement with clinicians.…”

European survey on preanalytical sample handling – Part 2: Practices of European laboratories on monitoring and processing haemolytic, icteric and lipemic samples. On behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EF

“…This principle could be used by laboratories to monitor phlebotomy quality in their health care setting as quality indicator, then taking further actions when the situation worsens e.g. on a specific ward ( 36 ). Tools to document and evaluate haemolysis indices are freely available ( 37 , 38 ).…”