Supplementary Files
Keywords
How to Cite
Abstract
Objective: To assess impact of stringent Internal Quality Control (IQC) checks on performance of proficiency testing
Material and methods: This was a Prospective study conducted between September 2020 and April 2021 at Chemical pathology lab of Fauji Foundation Hospital Rawalpindi. External quality control data (EQC) from the month of September was evaluated. As part of corrective action plan IQC checks were enforced, internal quality control (IQC) data of the month of September 2020 and April 2022 were assessed. Performance characteristics of routine chemistry analytes coefficient of variance (CV), standard deviations (SD)and Bias were calculated and compared using paired –T- test.
Results: Proficiency testing report (NEQAPP) of cycle 10 round 1 showed 11% External Quality Control (EQC) failure among 18 biochemical parameters. Serum Creatinine and Total Protein failed acceptability criteria with Z-score of greater than 2. As part of corrective action IQC checks were done, which led to improvement in CV (SD) of these parameters. The next EQC lab report for routine chemistry analytes met the acceptability criteria with z-scores of all anaytes being less than 2.
Conclusion: Precise & accurate IQC results lead to better performance in EQC results
References
B Rifai Nader et al. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Sixth ed. Elsevier 2018.
Ricós C, García-Victoria M, de la Fuente B. Quality indicators and specifications for the extra-analytical phases in clinical laboratory management. Clinical chemistry and laboratory medicine. 2004;42(6):578-82. doi: 10.1515/CCLM.2004.100
Alsina Kirchner MJ, Funes VA, Adzet CB, Clar MVD, Escuer MI, Girona JM, et al. Quality indicators and specifications for key processes in clinical laboratories: a preliminary experience. 2007. Clin Chem Lab Med. 2007;45(5):672-7. doi: 10.1515/CCLM.2007.122
Llopis MA, Trujillo G, Llovet MI, Tarrés E, Ibarz M, Biosca C, et al. Quality indicators and specifications for key analytical-extra analytical processes in the clinical laboratory. Five years’ experience using the Six Sigma concept. Clinical chemistry and laboratory medicine. 2011;49(3):463-70. doi: 10.1515/CCLM.2011.067.
Simundic A-M, Bölenius K, Cadamuro J, Church S, Cornes MP, van Dongen-Lases EC, et al. Joint EFLM-COLABIOCLI Recommendation for venous blood sampling. Clinical Chemistry and Laboratory Medicine (CCLM). 2018;56(12):2015-38. doi: 10.1515/cclm-2018-0602.
Rioja RG, Espartosa DM, Segovia M, Ibarz M, Llopis MA, Bauça JM, et al. Laboratory sample stability. Is it possible to define a consensus stability function? An example of five blood magnitudes. Clinical Chemistry and Laboratory Medicine (CCLM). 2018;56(11):1806-18. doi: 10.1515/cclm-2017-1189.
Llovet MI, Biosca C, Martínez-Iribarren A, Blanco A, Busquets G, Castro MJ, et al. Reaching consensus on communication of critical laboratory results using a collective intelligence method. Clinical Chemistry and Laboratory Medicine (CCLM). 2018;56(3):403-12. doi: 10.1515/cclm-2017-0374.
Ricós C, Fernandez-Calle P, Perich C, Westgard JO. Internal quality control–past, present and future trends. Advances in Laboratory Medicine/Avances en Medicina de Laboratorio. 2022;3(3): 243-252. doi.org/10.1515/almed-2022-0029
Büttner J, Borth R, Boutwell J, Broughton P, Bowyer R. International Federation of Clinical Chemistry. Committee on Standards. Expert Panel on Nomenclature and Principles of Quality Control in Clinical Chemistry. Approved recommendation (1980) on quality control in clinical chemistry. Part 2. Assesment of analytical methods for routine use. Clinica chimica acta; Clin Chim Acta. 1980 Sep 8;106(1):109F-120F.
Westgard JO, Barry PL, Hunt MR, Groth T. A multi-rule Shewhart chart for quality control in clinical chemistry. Clinical chemistry. 1981;27(3):493-501.
Westgard JO. A Total Quality-Control Plan with Right-Sized Statistical Quality-Control. Clin Lab Med. 2017 Mar;37(1):137-150. doi: 10.1016/j.cll.2016.09.011.
Kumar BV, Mohan T. Sigma metrics as a tool for evaluating the performance of internal quality control in a clinical chemistry laboratory. Journal of laboratory physicians. 2018;10(2):194-9. doi: 10.4103/JLP.JLP_102_17.
Lalani R, Zafar MN, Khurshid M. Efficacy of internal and external quality control in chemical pathology. JPMA The Journal of the Pakistan Medical Association. 1988;38(10):255-9.
Munir MU, Ijaz A. National External Quality Assurance Program Pakistan (NEQAPP) -A Milestone in Proficiency Testing in Pakistan. Ejifcc. 2016;27(4):344-50.
Sun H, Wang W, Zhao H, Zhang C, He F, Zhong K, et al. Internal quality control status for BNP and NT-proBNP in China from 2014 to 2017. Journal of clinical laboratory analysis. 2019;33(1):e22643. doi: 10.1002/jcla.22643. Epub 2018 Aug 13.
Jafri L, Khan AH, Ghani F, Shakeel S, Raheem A, Siddiqui I. Error identification in a high-volume clinical chemistry laboratory: Five-year experience. Scandinavian journal of clinical and laboratory investigation. 2015;75(4):296-300. doi: 10.3109/00365513.2015.1010175
Teshome M, Worede A, Asmelash D. Total Clinical Chemistry Laboratory Errors and Evaluation of the Analytical Quality Control Using Sigma Metric for Routine Clinical Chemistry Tests. Journal of multidisciplinary healthcare. 2021;14:125-36. doi: 10.2147/JMDH.S286679
Zhang S, Wang W, Zhao H, He F, Zhong K, Yuan S, et al. Status of internal quality control for thyroid hormones immunoassays from 2011 to 2016 in China. Journal of clinical laboratory analysis. 2018;32(1) :e22154. doi: 10.1002/jcla.22154
Lasky FD. Performance-Driven Quality Control. Zoe C. Brooks. Washington, DC: AACC Press, 2001, Clinical Chemistry. 2002;48(9):1632. doi.org/10.1093/clinchem/48.9.1632
Westgard JO, Westgard SA. Measuring Analytical Quality: Total Analytical Error Versus Measurement Uncertainty. Clin Lab Med. 2017;37(1):1-13. doi: 10.1016/j.cll.2016.09.001.
Keleş M. Evaluation of the clinical chemistry tests analytical performance with Sigma Metric by using different quality specifications - Comparison of analyser actual performance with manufacturer data. Biochemia medica. 2022;32(1):010703. doi: 10.11613/BM.2022.010703
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2023 Noreen Atzaz