External Quality Assessment beyond the analytical phase: an Australian perspective.

Tony Badrick,Stephanie Gay,Andrew Georgiou,Euan J Mccaughey

doi:10.11613/bm.2017.009

Abstract

External Quality Assessment (EQA) is the verification, on a recurring basis, that laboratory results conform to expectations for the quality required for patient care. It is now widely recognised that both the pre- and post-laboratory phase of testing, termed the diagnostic phases, are a significant source of laboratory errors. These errors have a direct impact on both the effectiveness of the laboratory and patient safety. Despite this, Australian laboratories tend to be focussed on very narrow concepts of EQA, primarily surrounding test accuracy, with little in the way of EQA programs for the diagnostic phases. There is a wide range of possibilities for the development of EQA for the diagnostic phases in Australia, such as the utilisation of scenarios and health informatics. Such programs can also be supported through advances in health information and communications technology, including electronic test ordering and clinical decision support systems. While the development of such programs will require consultation and support from the referring doctors, and their format will need careful construction to ensure that the data collected is de-identified and provides education as well as useful and informative data, we believe that there is high value in the development of such programs. Therefore, it is our opinion that all pathology laboratories should strive to be involved in an EQA program in the diagnostic phases to both monitor the diagnostic process and to identify, learn from and reduce errors and near misses in these phases in a timely fashion.

Highlights

Pathology is a crucial clinical tool, estimated to contribute to 60-70% of all critical decisions involving patient treatment [1]
For pathology services to be of value, the correct ordering of tests and interpretation of results is crucial
The External Quality Assessment (EQA) program we propose could take the form of a series of patient scenarios where a response would be required

Summary

Introduction

Pathology is a crucial clinical tool, estimated to contribute to 60-70% of all critical decisions involving patient treatment [1]. For pathology services to be of value, the correct ordering of tests and interpretation of results is crucial This is the responsibility of the treating clinician, and as such, can be considered as the pre- and post-laboratory or diagnostics phase [5]. Advances in Health Information and Communications Technology (ICT) means that ICT can be used to support EQA and assist clinicians when both ordering and interpreting pathology test results This combination has the potential to significantly reduce errors in the diagnostic phase of pathology testing. In the post-laboratory phase, ICT can be used to support EQA systems that aim to standardise result reporting, reduce the number of missed test results and improve the quality of pathology result interpretation. While further patient centric studies are required to fully assess the impact of Health ICT on patient safety, ICT combined with EQA has the potential to reduce errors in the diagnostic phase of the pathology process

Conclusions

Findings

21. To Err is Human