1. Proficiency Testing as a quality improvement tool
James Mwangi

2. Objectives Define Proficiency Testing (PT) Describe PT process
Detail the benefits of participating in PT schemes
Outline the role of each arm of the laboratory to ensure maximum utility of PT
Discuss the limitations of PT

3. Definition of PT
“A program in which multiple samples are periodically sent to members of a group of laboratories for analysis and/or identification; whereby each laboratory’s results are compared with those of other laboratories in the group and/or with an assigned value, and reported to the participating laboratories and others.” CLSI GP27-A2 27:8

4. PT organization /provider
PT process
PT organization /provider
Laboratory
Analyze
Evaluation
PT performance report
Return results
PT samples sent regularly
Receive PT report
Corrective Actions

5. PT benefits The lab as a whole Measure of lab quality
Tells “where we are” i.e. measures gaps or deficiencies
Early warning system for errors
Helps identify and resolve testing errors
Lab mistakes are prevented

6. PT benefits Laboratory personnel
Educational value (Identify training needs)
Identifies skills gap and possible areas of improvement
Boost personnel morale

7. PT benefits Physician No repeat testing
Increases confidence in the lab’s results

8. PT benefits Patient Increases patient confidence in the particular lab
Customer expectations met i.e. quality care
Reduces cost of medical care

9. PT benefits Hospital Director Enhanced confidence in the institution
Reduce wastage in repeated tests
Reduced external pressure to meet client expectations
Reduce cost and increase revenue

10. Determinants of an effective PT Program
Commitment of the three major players
PT Provider
Laboratory Personnel
Hospital or Laboratory Management

11. PT Provider Provide suitable PT materials
Use of appropriate statistical procedures,
Appropriate criteria for performance evaluation,
Providing useful summary reports to laboratories in a timely manner
Create education and training opportunities for participating laboratory staff

12. Laboratory personnel
Run PT samples on time and submit results before set deadline
Openly discuss PT reports with laboratory management
Take corrective actions and monitor their effectiveness
Maintain PT records
Advice management on programs of interest to the institution

13. Management Determine policies for PT (WHO, WHAT, WHEN, HOW)
Provide required resources
Monitor and discuss PT results and reports with laboratory staff
Supports corrective action measures
Communicates outcomes

14. Insights from PT reports
Accuracy of the test results
Personnel competency,
equipment maintenance,
condition of reagents,
pipette calibration,
cold chain maintenance,
interpretation skills
turn-around time

15. PT Limitations/ challenges
Correct Pear Grouping
Negative influence of the consensus mean by poor performing but dominant group.
Inadequate numbers in a pear group
Preferential treatment of PT samples by participants
Frequency of distribution of PT material
Choice of assigned values to use

16. Key Messages PT should help direct improvement efforts
PT is a responsibility of everyone in the laboratory
PT has to be carried out within the context of a complete system for appropriate quality in the lab
PT is a regulatory requirement for laboratories seeking accreditation

17. Q & A