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Wheeler SE, Blasutig IM, Dabla PK, Giannoli JM, Vassault A, Lin J, Cendejas KA, Perret-Liaudet A, Bais R, Thomas A, Amann EP, Meng QH. Quality standards and internal quality control practices in medical laboratories: an IFCC global survey of member societies. Clin Chem Lab Med 2023; 61:2094-2101. [PMID: 37327359 DOI: 10.1515/cclm-2023-0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The trueness and precision of clinical laboratory results are ensured through total quality management systems (TQM), which primarily include internal quality control (IQC) practices. However, quality practices vary globally. To understand the current global state of IQC practice and IQC management in relation to TQM the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on Global Laboratory Quality (TF-GLQ) conducted a survey of IFCC member countries on IQC practices and management. METHODS The survey included 16 questions regarding IQC and laboratory TQM practices and was distributed to IFCC full and affiliate member countries (n=110). A total of 46 (41.8 %) responses were received from all regions except North America. RESULTS Of the responding countries, 78.3 % (n=36) had legislative regulations or accreditation requirements governing medical laboratory quality standards. However, implementation was not mandatory in 46.7 % (n=21) of responding countries. IQC practices varied considerably with 57.1 % (n=28) of respondents indicating that they run 2 levels of IQC, 66.7 % (n=24) indicating they run IQC every 24 h and 66.7 % (n=28) using assay manufacturer IQC material sources. Only 29.3 % (n=12) of respondents indicated that every medical laboratory in their country has written IQC policies and procedures. By contrast, 97.6 % (n=40) of responding countries indicated they take corrective action and result remediation in the event of IQC failure. CONCLUSIONS The variability in TQM and IQC practices highlights the need for more formal programs and education to standardize and improve TQM in medical laboratories.
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Affiliation(s)
- Sarah E Wheeler
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- School of Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh, USA
| | - Ivan M Blasutig
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Division of Biochemistry, CHEO, Ottawa, Canada
- Eastern Ontario Regional Laboratory Association, Ottawa, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Pradeep Kumar Dabla
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Department of Biochemistry, G.B. Pant Institute of Postgraduate Medical Education & Research, Associated Maulana Azad Medical College, New Delhi, India
| | - Jean-Marc Giannoli
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Technical Direction Biogroup and Labac, Lyon, France
| | - Anne Vassault
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- University Paris City, France
| | - Ji Lin
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Core Diagnostics, Abbott Labs, Lake Forest, IL, USA
| | - Kandace A Cendejas
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Bio-Rad Laboratories, Quality Systems, Hercules, CA, USA
| | - Armand Perret-Liaudet
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Department of Biochemistry and Molecular Biology Hospices Civils de Lyon, Lyon, France
| | - Renze Bais
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Rbaisconsulting, Australia
| | - Annette Thomas
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Weqas, Cardiff and Vale University Health Board, Cardiff, UK
| | - Egon P Amann
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Philipps University Marburg, Marburg, Germany
- University of Applied Sciences, Hamm-Lippstadt, Hamm, Germany
- Consultant in Life Sciences, Quality Systems & Clinical Chemistry, Marburg, Germany
| | - Qing H Meng
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Milan, Italy
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Thakur V, Akerele OA, Randell E. Lean and Six Sigma as continuous quality improvement frameworks in the clinical diagnostic laboratory. Crit Rev Clin Lab Sci 2023; 60:63-81. [PMID: 35978530 DOI: 10.1080/10408363.2022.2106544] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Processes to enhance customer-related services in healthcare organizations are complex and it can be difficult to achieve efficient patient-focused services. Laboratories make an integral part of the healthcare service industry where healthcare providers deal with critical patient results. Errors in these processes may cost a human life, create a negative impact on an organization's reputation, cause revenue loss, and open doors for expensive lawsuits. To overcome these complexities, healthcare organizations must implement an approach that helps healthcare service providers to reduce waste, variation, and work imbalance in the service processes. Lean and Six Sigma are used as continuous process improvement frameworks in laboratory medicine. Six Sigma uses an approach that involves problem-solving, continuous improvement and quantitative statistical process control. Six Sigma is a technique based on the DMAIC process (Define, Measure, Analyze, Improve, and Control) to improve quality performance. Application of DMAIC in a healthcare organization provides guidance on how to handle quality that is directed toward patient satisfaction in a healthcare service industry. The Lean process is a technique for process management in which waste reduction is the primary purpose; this is accomplished by implementing waste mitigation practices and methodologies for quality improvement. Overall, this article outlines the frameworks for continuous quality and process improvement in healthcare organizations, with a focus on the impacts of Lean and Six Sigma on the performance and quality service delivery system in clinical laboratories. It also examines the role of utilization management and challenges that impact the implementation of Lean and Six Sigma in clinical laboratories.
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Affiliation(s)
- Vinita Thakur
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Olatunji Anthony Akerele
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada
| | - Edward Randell
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
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Xia Y, Wang X, Yan C, Wu J, Xue H, Li M, Lin Y, Li J, Ji L. Risk assessment of the total testing process based on quality indicators with the Sigma metrics. Clin Chem Lab Med 2021; 58:1223-1231. [PMID: 32146438 DOI: 10.1515/cclm-2019-1190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/09/2020] [Indexed: 11/15/2022]
Abstract
Background Evidence-based evaluation of laboratory performances including pre-analytical, analytical and post-analytical stages of the total testing process (TTP) is crucial to ensure patients receiving safe, efficient and effective care. To conduct risk assessment, quality management tools such as Failure Mode and Effect Analysis (FMEA) and the Failure Reporting and Corrective Action System (FRACAS) were constantly used for proactive or reactive analysis, respectively. However, FMEA and FRACAS faced big challenges in determining the scoring scales and failure prioritization in the assessment of real-world cases. Here, we developed a novel strategy, by incorporating Sigma metrics into risk assessment based on quality indicators (QIs) data, to provide a more objective assessment of risks in TTP. Methods QI data was collected for 1 year and FRACAS was applied to produce the risk rating based on three variables: (1) Sigma metrics for the frequency of defects; (2) possible consequence; (3) detection method. The risk priority number (RPN) of each QI was calculated by a 5-point scale score, where a value of RPN > 50 was rated as high-risk. Results The RPNs of two QIs in post-analytical phase (TAT of Stat biochemistry analyte and Timely critical values notification) were above 50 which required rigorous monitoring and corrective actions to eliminate the high risks. Nine QIs (RPNs between 25 and 50) required further investigation and monitoring. After 3 months of corrective action the two identified high-risk processes were successfully reduced. Conclusions The strategy can be implemented to reduce identified risk and assuring patient safety.
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Affiliation(s)
- Yong Xia
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Xiaoxue Wang
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Cunliang Yan
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Jinbin Wu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Hao Xue
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Mingyang Li
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Yu Lin
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Jie Li
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Lianhua Road No. 1120, Futian District, Shenzhen, Guangdong, P.R. China, Phone: +86-0755-83923333-2295
| | - Ling Ji
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Lianhua Road No. 1120, Futian District, Shenzhen, Guangdong, P.R. China, Phone: +86-0755-83923333-2299
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Eren F, Tuncay ME, Oguz EF, Neselioglu S, Erel O. The response of total testing process in clinical laboratory medicine to COVID-19
pandemic. Biochem Med (Zagreb) 2021; 31:020713. [PMID: 34140836 PMCID: PMC8183122 DOI: 10.11613/bm.2021.020713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/28/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Following a pandemic, laboratory medicine is vulnerable to laboratory errors due to the stressful and high workloads. We aimed to examine how laboratory errors may arise from factors, e.g., flexible working order, staff displacement, changes in the number of tests, and samples will reflect on the total test process (TTP) during the pandemic period. Materials and methods In 12 months, 6 months before and during the pandemic, laboratory errors were assessed via quality indicators (QIs) related to TTP phases. QIs were grouped as pre-, intra- and postanalytical. The results of QIs were expressed in defect percentages and sigma, evaluated with 3 levels of performance quality: 25th, 50th and 75th percentile values. Results When the pre- and during pandemic periods were compared, the sigma value of the samples not received was significantly lower in pre-pandemic group than during pandemic group (4.7σ vs. 5.4σ, P = 0.003). The sigma values of samples transported inappropriately and haemolysed samples were significantly higher in pre-pandemic period than during pandemic (5.0σ vs. 4.9σ, 4.3σ vs. 4.1σ; P = 0.046 and P = 0.044, respectively). Sigma value of tests with inappropriate IQC performances was lower during pandemic compared to the pre-pandemic period (3.3σ vs. 3.2σ, P = 0.081). Sigma value of the reports delivered outside the specified time was higher during pandemic than pre-pandemic period (3.0σ vs. 3.1σ, P = 0.030). Conclusion In all TTP phases, some quality indicators improved while others regressed during the pandemic period. It was observed that preanalytical phase was affected more by the pandemic.
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Affiliation(s)
- Funda Eren
- Central Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey
| | - Merve Ergin Tuncay
- Central Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey.,Department of Biochemistry, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Esra Firat Oguz
- Central Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey
| | - Salim Neselioglu
- Central Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey.,Department of Biochemistry, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Ozcan Erel
- Central Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey.,Department of Biochemistry, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
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Shcolnik W, Berlitz F, Galoro CADO, Biasoli V, Lopes R, Jerônimo D, Balli LB, Bernardes LH. Brazilian laboratory indicators benchmarking program: three-year experience on pre-analytical quality indicators. Diagnosis (Berl) 2021; 8:257-268. [PMID: 32866114 DOI: 10.1515/dx-2020-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In the laboratory medicine segment, benchmarking is the process in which institutions seek to compare with the macro environment (performance comparison and best practices with different laboratories) and improve their results based on quality indicators. The literature has highlighted the vulnerability of the pre-analytical phase in terms of risks and failures and the use of interlaboratory comparison as an opportunity to define a strategic performance benchmark aligned with the laboratory medicine sector, which has been a promising strategy to ensure continuous improvement, identifying within the pre-analytical process the critical activities to guarantee patient safety. In this context, this paper aims to present the three-year experience (2016-2018) of the Benchmarking Program and Laboratory Indicators - in Portuguese, Programa de Benchmarking e Indicadores Laboratoriais (PBIL) - with emphasis on pre-analytical indicators and their comparison against literature references and other programs of benchmarking in the area of laboratory medicine. PBIL is organized by the Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) in conjunction with Controllab and coordinated by a Brazilian group with representatives from different countries. METHODS The data presented in this paper involving the performance results of 180 laboratories with active participation. Results are presented in percentage (%, boxplot graphical in quartiles) and Sigma metric, recognized as the metric that best indicates the magnitude of failures in a process. The Pareto Chart was used to facilitate ordering and to identify the main errors in the pre-analytical phase. The Radar Chart was made available in this work for the purpose of comparing the results obtained in Sigma by the PBIL and IFCC Working Group Laboratory Errors and Patient Safety (WG LEPS). RESULTS In the study period, just over 80% of the pre-analytical failures are related to Blood culture contamination (hospital-based and non-hospital-based laboratories), Recollect and Non-registered exams, with failure rates of 2.70, 1.05 and 0.63%, respectively. The performance of the PBIL program participants was in line with the literature references, and allowed to identify benchmarks in the laboratory medicine market, target of PBIL, with best practices were observed for some indicators. CONCLUSIONS The results of the program demonstrate the importance of an ongoing program comparative performance-monitoring program for setting more robust goals and consequently reducing laboratory process failures. Even with these promising premises and results, the contextualized analysis of the program indicators, point to a still significant number of failures in our market, with possibilities for improvement in order aiming to ensure more robust and effective processes.
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Affiliation(s)
- Wilson Shcolnik
- Brazilian Society of Clinical Pathology/Laboratory Medicine, Rio de Janeiro, Brazil
- Institutional Relationship, Fleury Group, Rio de Janeiro, Brazil
| | - Fernando Berlitz
- Healthcare Consulting Solutions, Siemens Healthineers, São Paulo, Brazil
- Scientific Advisory, Controllab, Rio de Janeiro, Brazil
| | - Cesar Alex de O Galoro
- Brazilian Society of Clinical Pathology/Laboratory Medicine, Rio de Janeiro, Brazil
- Diagnostic Medicine, Sabin Group, Campinas, Brazil
| | | | - Rafael Lopes
- Services Management, Controllab, Rio de Janeiro, Brazil
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Oliver P, Fernandez-Calle P, Mora R, Diaz-Garzon J, Prieto D, Manzano M, Dominguez I, Buño A. Real-world use of key performance indicators for point-of-Care Testing network accredited by ISO 22870. Pract Lab Med 2020; 22:e00188. [PMID: 33251311 PMCID: PMC7677120 DOI: 10.1016/j.plabm.2020.e00188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022] Open
Abstract
Objective We aimed to evaluate the results of key performance indicators (KPIs) for a period of over three years, as well as their effectiveness as an improvement tool, to provide information about Point-of-Care Testing (POCT) management system performance and quality assurance. Design and methods KPIs regarding the global POCT process, extra-analytical phase, quality assurance and staff training and competency were evaluated for blood gases, HbA1c, sweat test and non-connected and connected glucose in an ISO 22870 accredited network. We established the definition of every KPI and its corresponding target. The results of KPIs from all clinical settings were appraised every month during the study period, taking corrective actions when necessary. Results Annual global results were generally acceptable. However, some clinical areas displayed deviations in specific months. The monitoring of these KPIs allowed us to detect the deviations immediately and identify their causes. These included errors in patient identification, consumables, strips, reagents, analyzers, calibration, internal and external quality control, sample management, connectivity, and operator identification strategy, among others. Conclusions The evaluation of these KPIs over time has shown their appropriateness. This set of quality indicators could be a useful tool for laboratory medicine leading POCT networks for better and safer patient care.
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Affiliation(s)
- Paloma Oliver
- Department of Laboratory Medicine, La Paz University Hospital. Madrid, Spain
| | | | - Roberto Mora
- Department of Laboratory Medicine, La Paz University Hospital. Madrid, Spain
| | - Jorge Diaz-Garzon
- Department of Laboratory Medicine, La Paz University Hospital. Madrid, Spain
| | - Daniel Prieto
- Department of Laboratory Medicine, La Paz University Hospital. Madrid, Spain
| | - Marta Manzano
- Department of Laboratory Medicine, La Paz University Hospital. Madrid, Spain
| | | | - Antonio Buño
- Department of Laboratory Medicine, La Paz University Hospital. Madrid, Spain
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