Shaimah Al-Failakawi Al Amiri Hospital Laboratory Quality Manager Identification and Implementation of Quality Indicators For Clinical Laboratories Shaimah Al-Failakawi Al Amiri Hospital Laboratory Quality Manager

Objectives Definition Identification Implementation Monitoring Quality and Quality Indicators Definition Identification Implementation Monitoring Evaluation

Essential Essential to all aspects of health care are laboratory results that are -Accurate, -Reliable, and -Timely

Quality Indicator The term “Quality Indicator” refers to a systematic measurement process intended to provide information about the quality of a system. Quality requires planning of the processes and procedures that develop appropriate, measurable, interpretable information upon which action can take place in the cycle of continuous improvement. Those procedures can be referred to as Quality Indicators.

Quality Management An active program of Quality Management allows the laboratory to monitor for Medical error with the intended goals of early detection and rapid remediation and correction, and more importantly, prevention of errors before they occur.

Indicators of Quality are Necessary Medical errors can result in annoyance and inconvenience such as time lost or necessitated patient revisits, but can also result in the more serious consequences of diagnostic delay or error, inappropriate therapy, and worse, increased risk of patient illness, debility, and sometimes death.

Quality Management System Definition All aspects of the laboratory operation need to be addressed to assure quality; this constitutes a quality management system.

How to Choose A Quality Indicator (Performance Measure) Identify an area to analyze from the laboratory phases Perform statistical analysis on the chosen topic Compare with reference materials for target goals Follow-up and place an action plan

Laboratory Analysis Examination Phase Path of Workflow THE PATIENT Test selection Sample Collection Preexamination Phase Sample Transport Laboratory Analysis Examination Phase Report Transport Report Creation Result Interpretation Postexamination Phase

Complexity of a Laboratory System Preexamination Reporting Patient/Client Prep Sample Collection Personnel Competency Test Evaluations Data & Laboratory Management Safety Customer Service Postexamination Sample Receipt and Accessioning Record Keeping Sample Transport Quality Control Testing Examination

Laboratory Phases Pre analytical : The quality of events that occurs before specimen arrive in the laboratory and account for 75% of laboratory errors Analytical : The quality of events that occurs within the laboratory i.e., the process phase. Post analytical : The quality of events that occur after results leave the laboratory

Pre analytical Variables Physician Test Knowledge Appropriateness of Test Selection Physician Test Ordering Patient Preparation Patient Identification Specimen Labelling/ Identification Adequacy of specimen information Specimen Collection/Complication of phlebotomy Sample rejection rate Specimen Delivery Processing and Preparation

Analytical Variables Specimen Analysis Critical value reporting Housekeeping record ( Incidence of sample spillage) Report Review or Verification Results Review Incidence of needle stick & other injuries Quality control (IQC & EQAS)

Post Analytical Variables Turnaround Time Notification of Critical Values Report Accuracy and Completeness Incidence of Typographical error Report Delivery Physician Follow-up Interpretive Consultation Customer Satisfaction

Other Important Indicators Continual improvement through CME / Training / Seminars Equipment Down Time Participation and Performance of EQAS programme Performance of IQC Performance of Inter laboratory Comparison Cost-related Outcomes Reimbursement related Laboratory Staff immunization status Proper waste Disposal

Specimen labeling and Identification The specimen should be representative, properly collected, preserved, and labeled. The ideal is to get the right sample for the right test at the right time.

Sample collection & Transportation

Sample rejection rate Total no. of sample received in that month Percentage of sample rejected per month in the laboratory. Total no. of sample rejected in one month X 100 Total no. of sample received in that month

Criteria for sample rejection Sample is collected in improper vaccutainer Sample improperly labeled or unlabeled Specimen without properly completed request form Specimen sample volume insufficient for requirement of test protocol If separated serum or plasma is grossly hemolyzed

Analytical Measurement Instrument not calibrated properly Specimen mix-up Incorrect volume of specimen Interfering substance present Instrument precision problem

Turn Around Time This indicator refers to the percentage of specific laboratory tests that do not meet a reporting deadline. There are no widely accepted turnaround time (TAT) goals for specific laboratory tests. Laboratories most commonly (41%) defined TAT as time of test request to the time of results reporting

Typographical Errors Wrong name of the patient Errors due to patient with same name Wrong registration no. Wrong age / gender Typographical error of reporting

Al Amiri Example Process The next slide will show the work Al Amiri laboratory department have submitted in regards to quality indicators and the action plan

Refer to the T-A-T Example

Absence of evidence is not the evidence of absence Always look for what is wrong before looking who is wrong!

Exercise 1- Take a blank form and think about what type of quality indicator you can perform at your PHC 2- Write it down and start filling out the form 3- On the back write down how you think you can measure this indicator and why you chose it as an indicator for your PHC