Role of Intervention on Laboratory Performance: Evaluation of Quality Indicators in a Tertiary Care Hospital

Quality in laboratory has huge impact on diagnosis and patient management as 80–90% of all diagnosis is made on the basis of laboratory tests. Monitoring of quality indicators covering the critical areas of pre-analytical, analytical and post-analytical phases like sample misidentification, sample rejection, random and systemic errors, critical value reporting and TATs have a significant impact on performance of laboratory. This study was conducted in diagnostic laboratories receiving approximately 42,562 samples for clinical chemistry, hematology and serology. The list of quality indicators was developed for the steps of total testing process for which errors are frequent and improvements are possible. The trend was observed for all the QI before and after sensitisation of the staff over the period of 12 months. Incomplete test requisition form received in the lab was the most poor quality indicator observed (7.89%), followed by sample rejection rate (4.91%). Most significant improvement was found in pre- and post-analytical phase after sensitisation of staff but did not have much impact on analytical phase. Use of quality indicators to assess and monitor the quality system of the clinical laboratory services is extremely valuable tool in keeping the total testing process under control in a systematic and transparent way.     

Application of Sigma Metrics for the Assessment of Quality Assurance in Clinical Biochemistry Laboratory in India: A Pilot Study

Ensuring quality of laboratory services is the need of the hour in the field of health care. Keeping in mind the revolution ushered by six sigma concept in corporate world, health care sector may reap the benefits of the same. Six sigma provides a general methodology to describe performance on sigma scale. We aimed to gauge our laboratory performance by sigma metrics. Internal quality control (QC) data was analyzed retrospectively over a period of 6 months from July 2009 to December 2009. Laboratory mean, standard deviation and coefficient of variation were calculated for all the parameters. Sigma was calculated for both the levels of internal QC. Satisfactory sigma values (>6) were elicited for creatinine, triglycerides, SGOT, CPK-Total and Amylase. Blood urea performed poorly on the sigma scale with sigma <3. The findings of our exercise emphasize the need for detailed evaluation and adoption of ameliorative measures in order to effectuate six sigma standards for all the analytical processes.     

Measurement of Errors in Clinical Laboratories

Laboratories have a major impact on patient safety as 80–90 % of all the diagnosis are made on the basis of laboratory tests. Laboratory errors have a reported frequency of 0.012–0.6 % of all test results. Patient safety is a managerial issue which can be enhanced by implementing active system to identify and monitor quality failures. This can be facilitated by reactive method which includes incident reporting followed by root cause analysis. This leads to identification and correction of weaknesses in policies and procedures in the system. Another way is proactive method like Failure Mode and Effect Analysis. In this focus is on entire examination process, anticipating major adverse events and pre-emptively prevent them from occurring. It is used for prospective risk analysis of high-risk processes to reduce the chance of errors in the laboratory and other patient care areas.     

省级农用地分等的质量控制方法研究

与县级农用地分等相比,省级农用地分等具有以下特点:县与县之间的等别要有可比性、行政区域边界等别要协调(能接边)、多层次,即一次工作可同时完成省、市、县三级成果、数据管理难度大等.因此在以省为单位进行农用地分等时,如何保证分等成果的质量成了关键技术问题.河南省采用过程控制和多途径结果检验相结合,对农用地分等质量进行控制.过程监控是指从工作底图标准化开始,到基础数据的调查整理与录入、分等参数选择、指数计算等,都要保证工作过程的每一个环节科学、准确;多种途径对成果进行检验包括宏观规律分析、微观差异分析、分等指数的统计分析、等别收益验证、与以往成果对比分析、实地验证等,多方面检验成果是否合理、是否符合实际.河南省农用地分等实践证明,过程控制和多途径结果检验相结合的质量控制方法,在保证分等结果科学性与合理性(符合实际)基础上,又保证了县级分等成果精度,符合技术<规程>的要求、解决了行政区域边界接边的困难、省域内分等成果的可比,而且省时、省力.     

Evaluation of Sigma-Metric and Application of Quality Tools in Clinical Laboratory of a Tertiary Care Hospital

Variability in analytical performance of some analyte indicated the need of evaluation of quality plan of our laboratory. We tried to put the same degree of effort into our quality metrics as we put into the laboratory processes themselves. Application of six sigma methodologies improve the quality by focusing on the root causes of the problems in performance and analyzing by flowcharts, fishbone diagrams and other quality tools. Sigma metric was calculated for laboratory parameters for a period of 8 months during 2018–19. The analytes with poor sigma metric were free Thyroxine (FT3, FT4), Sodium, Calcium and Magnesium. Sigma metric of free Thyroxine (FT3, FT4), Sodium, Calcium and Magnesium were below 3. A road map for process improvement was designed with DMAIC (Define-Measure-Analyze-Improve-Control) model to solve the issue. Possible causes for low analytical performance of the particular analytes were depicted in Fishbone diagram. The Fishbone analysis identified the water quality issues with electrolyte analysis while high ambient temperature was culprit for poor assay performance of free Thyroxine. Sigma metric of the analytical performance was assessed once again after root cause analysis. Sigmametric showed marked improvement in control phase. Identification of problems led to reduction in non value added work leading to adequate resource utilization by addressing the priority issue. Therefore, DMAIC tool with Fish bone model analysis can be recommended as a well suited method for troubleshooting in poor performance of laboratory parameter.     

Validation Protocol: First Step of a Lean-Total Quality Management Principle in a New Laboratory Set-up in a Tertiary Care Hospital in India

Method validation is pursued as the first step in establishing Lean-Total Quality Management in a new clinical laboratory, in order to eliminate error in test results. Validation of all the new tests were done (with particular reference to alkaline phosphatase) by verifying reference intervals, analytical accuracy and precision, inter-assay and intra-assay variations, analytical sensitivity, limit of detection, linearity and reportable range, i.e. (i) Analytical measurement range (AMR) and (ii) Clinically reportable range (CRR). Our obtained reference range was within that of the manufacturer’s and showed high degree of analytical accuracy between two laboratories (r ² = 0.99). Precision was comparable with the manufacturer’s claim with inter-assay variation CV 1.04% and intra-assay variation CV 1.54%. Lowest limit of detection was 1.0324 ± 0.007 with CV 0.34%. AMR was also verified with CV 1.26 and 0.69%, for level 1 and level 2 control sera, respectively. The assay was linear with different dilutions. Lean concept was also verified with high recovery percentage. Validation ensures that accurate and precise results are reported in a clinically relevant turn around time.     

剖析用拉脱法测量液体表面张力系数实验误差的原因

任何物理实验不可避免会产生实验误差,一般实验误差呈正态分布,有的实验结果偏大,有的实验结果偏小,这样实验误差才正常。而用拉脱法测量液体表面张力系数的实验误差大小主要取决于操作是否合理,操作准确无误,误差就小。所以老师应该在学生操作之前讲清楚如何拉膜以及拉膜过程中一定要做到玻璃套筒上的刻度线,与反光镜面上刻度线以及玻璃套筒上的刻度线的镜像线三线合一,否则就会产生比较大的实验误差。让学生在操作之前就知道出现误差真正的原因,在实验操作过程中尽量避免出现操作的误差。     

Identification of Pre-examination Errors in the Chemical Pathology Laboratory at the University Hospital of the West Indies

This study evaluated the types and frequencies of pre-examination errors recorded in the chemical pathology laboratory at the University Hospital of the West Indies, Jamaica. This was a retrospective analysis of errors recorded over a three year period. Data analysis was done on an average of 519,084 samples collected and tested per year. Samples included blood, urine, stool and other fluids. Pre-examination errors were identified and recorded following visual inspection of the samples and corresponding request forms by laboratory staff, then subsequently by the Senior Medical Technologist. Errors were generally classified as inappropriate sample (58 %), inappropriate form (23.4 %), inappropriate sample volume (9.3 %) and inappropriate sample tube (9.3 %). Over 90 % of recorded pre-examination errors were related to blood samples while urine samples accounted for 6.8 % error. Pre-examination errors were lower at this study location than elsewhere. Measures aimed at reducing instances of these errors are recommended for improved laboratory quality output.     

汉语负迁移视角下的英语写作持续性错误的教学对策研究

英语专业的本科生在英文日常写作中频繁出错,出错的原因大多与汉语负迁移有关。然而,高等教育研究却并未就此类高频错误提供系统的教学对策。因此,该文重在探讨英语专业写作教学的实践效果,通过案例分析,采用师生交互批改模式来纠正学生的持续性错误,并对后续研究系统化的教学实践对策提供一些思路。     

试论绩效评估信息的质量控制——基于科技资源建设与服务机构经费投入的分析

近年来,国家对科技资源建设与服务机构进行了持续的经费投入,如何对其进行有效的绩效评估成为科技管理部门面临的重要问题。在研究不同阶段评估工作的基础上,分析绩效评估信息质量现状,并进一步探讨如何保障评估信息质量,以加强评估对经费投入的指导意义。     

压力管道阀门入库检查和验收的质量控制要点

结合工作中阀门安装的实例,分析了压力管道阀门入库验收过程中出现的问题及其产生的原因,提出了相应的质量控制要点。     

Study of Variables Affecting Critical Value Notification in a Laboratory Catering to Tertiary Care Hospital

During post-analytical phase, critical value notification to responsible caregiver in a timely manner has potential to improve patient safety which requires cooperative efforts between laboratory personnel and caregivers. It is widely accepted by hospital accreditors that ineffective notification can lead to diagnostic errors that potentially harm patients and are preventable. The objective of the study was to assess the variables affecting critical value notification, their role in affecting it’s quality and approaches to improve it. In the present study 1,187 critical values were analysed in the Clinical Chemistry Laboratory catering to tertiary care hospital for neuropsychiatric diseases. During 25 months of study period, we evaluated critical value notification with respect to clinical care area, caregiver to whom it was notified and timeliness of notification. During the study period (25 months), the laboratory obtained 1,279 critical values in clinical chemistry. The analytes most commonly notified were sodium and potassium (20.97 & 20.8 % of total critical results). Analysis of critical value notification versus area of care showed that critical value notification was high in ICU and emergency area followed by inpatients and 64.61 % critical values were notified between 30 and 120 min after receiving the samples. It was found that failure to notify the responsible caregiver in timely manner represent an important patient safety issue and may lead to diagnostic errors. The major area of concern are notification of critical value for outpatient samples, incompleteness of test requisition forms regarding illegible writing, lack of information of treating physician and location of test ordering and difficulty in contacting the responsible caregiver.     

关于我国实验动物质量监督问题的研究

联系我国实验动物质量监督工作实际,提出我国实验动物质量体系建设的对策思路,并对质量监督体系建设中的法律法规、监督机构、社会认识和行业监督等内容进行了重点阐述,为我国实验动物质量监督工作提供理论指导作用。     

基于非专业因素影响的高校毕业生就业质量评价研究

近年来,受国际金融危机和高等教育改革的影响,高校毕业生的就业形势越来越严峻,就业质量不容乐观,高校毕业生的就业问题特别是就业质量问题备受关注。大学生专业素质是就业的前提,但是只有良好的专业知识和技能并不能保证高质量的就业,非专业因素影响也尤为重要,因此从非专业因素层面构建高校毕业生就业质量评价体系具有十分重要的意义。     

赣州加快建设品质城市研究

城市品质是反映城市内在精神的品位和反映城市内在本质的质量的统一体。加快城市品质建设,是顺应城市发展规律的战略选择,是进一步彰显赣州城市特色、提升城市核心竞争力的迫切需要。本文基于城市品质的内涵和内在本质理论,通过对赣州城市品质发展现状的调研和分析,力图找到赣州加快建设品质城市的合适路径。     

Stability of Lyophilized Human Serum for Use as Quality Control Material in Bhutan

Quality control (QC) materials are crucial for internal quality control (IQC) and external quality assessment scheme (EQAS). However, many developing countries are disadvantaged by unavailability and high cost of commercial control material. Therefore, preparing home-made lyophilized human serum will be cost effective for used as a QC material in Bhutan. We prepared lyophilized QC material using serum collected from Bhutanese volunteers. The stability of lyophilized serum was studied at 3 selected conditions by analyzing at certain intervals. The results were statistically compared with initial values. The significant p values (<0.05) were seen in glucose, BUN, ALT, total bilirubin and protein at 2–8 °C but no significant difference were observed at −20 °C at the end of 9 months. We concluded that, home-made lyophilized human serum prepared without stabilizers could be used at least up to 9 months if stored at −20 °C and 7 months at 2–8 °C. Stabilizers and additives are necessary if the materials are to be used longer than 7–9 months.     

数据组织过程中的数据质量评价研究

以基于生命周期的数据质量管理框架为出发点,提出了数据组织过程中的数据质量评价模型和方法,包括数据质量维度、数据质量评价指标、数据质量综合评价模型以及数据质量评价方法等。该模块与方法对提高数据质量和加强数据运用具有重要意义。     

中国质量管理的学科定位与学术地位问题研究

简述了质量管理学的产生和发展历史,分析了质量管理、质量科学、质量工程三个概念的区别与联系,认为质量管理应是规范的学科名称。重点对其学科定位和学术地位问题进行了讨论。认为质量管理学没有得到社会足够的重视和关注。中国要在科学发展观指导下建立和谐社会,必须重视质量管理学科,重视社会经济发展质量问题的研究。     

浅谈药品检验实验室测量设备的期间核查

为了保证检测数据的准确和可靠,使测量设备处于满足预期使用要求的状态,缩短失准后的追溯时间,尽可能降低风险和成本。文章提出了期间核查的必要性,主要对象,归纳了一些常见核查方法及结果的处理。     

基于质量控制点和质量标准 构建高校教学质量保障体系

依据系统论、信息论等现代理论,我们要全面梳理高校在人才培养过程中的环节,确定质量控制点,制定质量标准,构建全面的本科教学质量保障体系。本文阐述了质量保障体系的主动性、激励性、目标性、全员性、系统性、全程性原则及质量保障体系的四个系统：主要质量控制点系统、教学质量评价系统、教学质量信息反馈与改进提高系统、教学质量组织系统。