Thursday, April 28, 2005

Quality Improvement Through Investigation of External Quality Assessment Discordant Findings

Harold Richardson and Jane Gun-Munro.

Quality Management Program-Laboratory Services (QMP-LS) provides mandatory external quality assessment (EQA) of laboratories in Ontario. Participants are required to formally investigate discordant findings and submit a structured report to QMP-LS for analysis.

To provide guidance to laboratories in cause-analysis, identification and monitoring of corrective action.

Participants were given instructions on root cause analysis of error. Participants reporting EQA survey results outside of acceptable limits then received a form designed to investigate errors. The responses were categorized as clerical, method, technical or random errors.

Clerical Errors: Most were transcription errors. EQA Material Errors: There were relatively few material errors. All involved incorrect storage of material. Method Errors: In clinical chemistry and haematology, most errors were instrument-related including method validation, maintenance and calibration and/or variation associated with reagents. Some Q.C. limits were too wide. Other errors included use of outdated or non-validated reference intervals. In microbiology and transfusion medicine, errors were associated with inadequately documented processes or procedures. Technical Errors: These were associated with specimen preparation and/or handling, failure to act on QC results, failure to follow documented procedures, inexperience or simply poor technique. Random Error: This was assigned largely because the cause was unknown. Root Cause: The root cause for the error was frequently not identified in participant responses. When identified, the most commonly cited cause was lack of awareness or understanding by laboratory staff. Corrective Action: Most corrective actions were appropriate, and included re-writing of procedures and re-education and training of staff.

Categorization of discordant findings in EQA surveys assists laboratories in identifying opportunities for improvement and developing root cause analysis and corrective action.

See more of Poster Session
See more of The 2005 Institute for Quality in Laboratory Medicine Conference