The role of external quality assurance in progressing quality in haemostasis: initiatives from the RCPA QAP

Abstract

The Haematology Quality Assurance Program (QAP) has been conducting proficiency testing in haemostasis for over 40 years. Regular multilaboratory surveys, with peer group assessments, are sent out 2–8 times a year, depending on the specialty. The face of haemostasis testing has changed considerably over the past decade and this has presented many challenges for external quality assurance in haemostasis. One area that has seen considerable expansion is international normalised ratio (INR) point of care (POC) instruments for monitoring warfarin therapy, and this has resulted in the development of the POC-INR program in recent years. The past 7 years has also seen the expansion of the Special Haemostasis program to include testing for lupus anticoagulant, protein C and S, activated protein C resistance and von Willebrand factor. Many other new initiatives have been introduced including the factor inhibitor study exercises, PFA-100 testing trials, and D-Dimer special exercises. The evaluation of results from a broad range of laboratories, expert and non-expert alike, have helped identify potential issues within the haemostasis testing. With our expert advisory committee, the RCPA QAP has been able to provide suggestions to help minimise potential diagnostic errors in this field. 1