1. 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

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

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

4. 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.

5. 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.

6. 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.

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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)

14. 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

15. 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

16. 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.

17. Sample collection & Transportation

18. 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

19. 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

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

21. 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

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

23. 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

24. Refer to the T-A-T Example

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

29. 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