Barbara De la Salle UK NEQAS
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1 Barbara De la Salle UK NEQAS
2 Right Blood Right Result - Right Time Every Time
3 Right Test Right Action Right Patient Right Sample Right Result Right Experience Right Time Right Cost
4 Systematic quality improvement Pressure to improve nonlaboratory activities Demonstration of leadership by pathology providers Cost reduction Key Assurance Indicators
5 Design Working Group members Pre-pilot selected UK participants Pilot UK participants
6 Design Working Group members Pre-pilot selected UK participants Pilot UK participants
7 Type I: Registration of procedures Type II: Circulation of samples simulating errors Type III: Registration of errors/adverse events Gunn BB Kristensen et al. Biochemica Medica 2014; 24 (1):
8 Type I: Registration of procedures Type II: Circulation of samples simulating errors Type III: Registration of errors/adverse events Gunn BB Kristensen et al. Biochemica Medica 2014; 24 (1): EQA error rates and causes gathered through corrective and preventative actions or root cause analysis investigation
9 59 quality indicators 34 Pre-analytical 7 Analytical 15 Post-analytical 3 Support processes Sciacovelli L et al. Clin Chem Lab Med 2011; 49(5): Plebani M et al. Clin Chem Lab Med 2013; 51(1):
10 Appropriate request Patient identification Request form Order entry Sample identification Sample collection Sample transportation Sample rejection
11 Timeliness of reports Accuracy of results reporting Timeliness and effectiveness of critical values reporting Effectiveness of interpretative comments Effectiveness of clinical audit
12 Inappropriate test request Frequency of requesting Justification of request Special requirements Communication of urgency/critical samples Correct/adequate clinical information Variability in clinical practice General practice v. Hospital Wrong blood in tube Patient identification errors
13 Inappropriate test request Frequency of requesting Justification of request Special requirements Communication of urgency/critical samples Correct/adequate clinical information Variability in clinical practice General practice v. Hospital Wrong blood in tube when identifiable
14 Wrong site for sampling Sample identification Barcode Sample time/temperature Sample quality Fill volume Anticoagulant Order of draw Mixing Packaging and transport Lost samples
15 Wrong site for sampling when identifiable Sample identification Barcode Sample time/temperature where critical Sample quality Fill volume Anticoagulant Order of draw Mixing Packaging and transport Lost samples - how do we know?
16 Turnaround time for report authorisation Time between authorisation and receipt Communication of critical results Wrong person/wrong place informed Out of hours Competency of lab staff/recipient Transcription error Results lost Results not seen No audit trail
17 Turnaround time for report authorisation Time between authorisation and receipt Communication of critical results Wrong person/wrong place informed Out of hours Competency of lab staff/recipient Transcription error Results lost Results not seen No audit trail
18 Inappropriate interpretation Lab Clinician Inappropriate/no instruction from lab Urgency of action not conveyed Inappropriate action/inaction by clinician Results not used clinically GENERAL PRACTICE v HOSPITAL CLINICIAN
19 Identification indicators (2): Patient identification Sample identification Sample quality indicators (6) Inappropriate sample type or container Insufficient sample volume Sample transportation Sample quality (Blood Sciences) Sample quality (Microbiology) Contaminated blood cultures
20 Timeliness of reports Accuracy of results reporting Timeliness and effectiveness of critical results reporting in-patients only
21 Blood Sciences Haematology Chemistry Immunology Microbiology Pilot: UK Laboratories only Next phase: Republic of Ireland Then: Possible availability through EQALM or similar collaborative working Later roll out to Histopathology and Cytology
22 Web only service Wolfson EQA database (SQL) Pan UK NEQAS centre set up Input screen developed Vocabulary drafted to generate analyte codes Input items (analytes) # failures # opportunities (requests/patients/reports) Data processing Defects per million opportunities Sigma metric
23 Pre-pre-pilot : WG members only Plausibility/feasibility check Data not attributable to participants Volatile identifier codes and passwords Feedback: Standardisation of data input terminology Clarification of time period for data capture Glossary needed, as well as standard access instructions
24 To define: Request Sample/specimen Patient identification failure Sample identification failure Blood Sciences Microbiology Quality rejections Etc.
25 Design Working Group members Pre-pilot selected UK participants Pilot UK participants
26 Open NOW Selected laboratories only (10-20) Haematology Chemistry Microbiology Volatile identifiers / passwords Data not attributable to participants To assess practicality and preferences
27 Ownership and collaboration Stakeholder focus Who will pay? Feasibility Practical data collection Different LIMS systems Networks vs individual sites GP vs hospital Service reorganisation Glossary
28 16 suggestions Adverse incident monitoring service Key Quality Indicator System End to end quality assessment and so on... UK NEQAS Pre and Post Analytical Quality Monitoring Service
29 Jen Atherton Ian Mellors David Bullock Christine Walton UK NEQAS Administration UK NEQAS Pre and Post Analytical WG Participants brave enough to take part
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