Practicalapplication of Six Sigma Dmaic Methodology in Evaluation of Pre-Analytical Quality Indicators in Laboratory Settings

Abstract

The Six Sigma is a global management methodology that empowers clinical laboratories by better understanding of the quality in their laboratories and helps in improving quality and subsequently reducing laboratory costs. The objective of this prospective study was to practically apply Six Sigma on pre-analytical quality indicators i.e. pre-analytical phase errors of “Total Testing Process” in laboratory at PGIMER Satellite Centre, Sangrur (Punjab). In this study Six Sigma DMAIC ( Dene, Measure, Analyse, Improvement and Control) methodology was applied on routine Outpatient Department (OPD) samples received in hematology and biochemistry laboratory from May, 2020 to July, 2020 after institutional ethical committee permission. Pre-analytical phase errors were taken as pre-analytical quality indicators and were broadly classied in to requisition form and sampling errors. Sigma values and frequencies were calculated using Westgard formula present online at (www. westgard.com > six sigma calculators) for pre-analytical phase errors. After that Improvement phase of DMAIC methodology was done by training of laboratory technicians or personell involved in pre-analytical phase by audio-visual aids. Six Sigma values were calculated again after improvement phase. A total of 787 requisition forms and 1105 samples were studied before improvement phase and 889 requisition forms and 1400 samples were studied after improvement phase. Before improvement phase, overall requisition form errors were working at 2.9 sigma and sampling process was working at 3.1 sigma but after improvement phase, requisition form errors were working at 3.3 sigma and sampling process was working at 3.5 sigma. Before and after improvement phase the sample rejection rate in laboratory improved from 1.90% to 0.93% highlighting the benecial concept of six sigma in laboratory in pre-analytical phase leading to increased clinicians and patients'satisfaction and prevents unusual delaying of reports.