Prothrombin Time Testing Practices in the Pacific Northwest: Monitoring voluntary practice guidelines and indicators of quality

Prothrombin Time Testing Practices: Adherence to Guidelines and Standards

“…According to consensus guidelines developed by the CAP, laboratories should determine the sensitivity of their PT assay to heparin and, where possible, select a thromboplastin that is insensitive to heparin in the therapeutic range (1 ). In the 2004 PT survey, 12% of respondents reported determining sensitivity of their PT assays to heparin, whereas 42% reported selecting a thromboplastin reagent that was insensitive to heparin in the therapeutic range (2 ). These results were quite comparable to the data obtained in the 2001 survey of US hospital laboratories, in which 16% reported determining the sensitivity of their PT assays to heparin and 45% reported selecting a thromboplastin reagent that was insensitive to heparin in the therapeutic range ( …”

“…Several organizations, including the Clinical and Laboratory Standards Institute (CLSI; formerly NCCLS), College of American Pathologists (CAP), and American College of Chest Physicians, recommend using only thromboplastins with an ISI of 1.70 or less (2,5 ). Several published studies have reported ISI values used by survey participants that together suggest increasing use of lower-ISI reagents.…”

“…Several published studies have reported ISI values used by survey participants that together suggest increasing use of lower-ISI reagents. In the 2004 survey of PT testing practices, 67% reported ISIs of Յ1.70 for their current thromboplastin lots (2,5 ), whereas in the 2001 survey of US hospital laboratories, 40% reported using thromboplastins with ISIs of Յ1.70 (1 ). The increasing use of lower-ISI reagents may have resulted from publication of guidelines advocating their use and thus contributing to their increasing availability.…”

“…Some laboratories, however, fail to follow voluntary practice guidelines for coagulation testing (1,2 ), and inappropriate performance of coagulation tests, such as the prothrombin time (PT) test, may contribute to coagulation and bleeding complications (3,4 ). A 2001 survey of coagulation laboratory testing practices in a randomly selected sample of US hospitals revealed substantial variability in laboratory practices (1 ).…”

“…The lack of agreement between reported practices and recommendations (1 ) demonstrated a need to understand the reasons for noncompliance to better promote adherence to laboratory practice guidelines and standards. In a 2004 survey of hospital laboratories and of independent and point-of-care (POC) laboratories in the US Pacific Northwest, we evaluated PT testing practices to determine the extent to which laboratories used specific practice guidelines and standards and assessed why some testing sites did not adhere to specific recommendations and regulatory standards (2,5 ). Here we compare the findings of the 2001 and 2004 surveys (1,2,5 ) and discuss the extent to which guidelines are followed for certain PT testing practices.…”