Results of a Quality Improvement Program for Sweat Testing to Diagnose Cystic Fibrosis

Abstract

Background: Obtaining an adequate volume of sweat to measure chloride is a challenge for many cystic fibrosis centers. The standard for patients older than 3 months is a less than 5% quantity not sufficient (QNS) rate; the suggested goal for patients aged 3 months or younger is a less than 10% QNS rate. St. Alexius Medical Center (SAMC) began performing sweat chloride testing in 2008. After an initial period of testing, a quality improvement (QI) program for sweat testing was instituted to improve QNS rates. Methods: Quantity not sufficient rates were evaluated before and after implementation for patients aged 3 months or younger and those older than 3 months. The QNS rates for each technician performing the tests were also evaluated. Results: Improvement was observed in QNS rates after implementation of the QI initiative regardless of patient age. After QI was implemented, QNS rates improved for most technicians. Conclusion: This study demonstrates how a QI improvement initiative can significantly improve QNS rates in sweat testing of infants, especially under 3 months of age. * CF : cystic fibrosis QNS : quantity not sufficient CFCC : Cystic Fibrosis Center of Chicago SAMC : St. Alexius Medical Center QI : quality improvement CAP : College of American Pathologists CLSI : Clinical and Laboratory Standards Institute