Internal Control Assessment Research Articles

A-189 Six Sigma for Thyroid Stimulating Hormone (TSH)

Abstract Background Effective quality control processes within clinical laboratories are crucial for monitoring and assessing the analytical performance in terms of precision and accuracy. The regular measurement of these parameters plays a pivotal role in ensuring patient safety and is often a prerequisite for accreditation by various organizations. Six Sigma metrics have emerged as one of the most efficient tools for evaluating the analytical performance of clinical laboratory systems. This approach integrates Total Allowable Error (TEa), encompassing both random and systematic errors into a single comprehensive index. This study details the establishment of Six Sigma in our laboratory for Thyroid Stimulating Hormone (TSH) for eight different modules of Siemens Atellica IM. Methods A one-year dataset was compiled from the assessment of internal quality control for evaluating the imprecision (expressed as coefficient of variation - CV%) and Bio Rad’s Unity Interlaboratory Program for inaccuracy (quantified as bias%) in TSH test processed across eight modules of Atellica IM (Siemens). The data was categorized into two groups based on QC levels. The TEa utilized in this study was set at 20% according to CLIA standards. Six Sigma metrics were subsequently calculated for each QC level and equipment based on TEa, CV%, and bias%, utilizing the formula Sigma=(TEa - bias%)/CV%. Results Six Sigma values calculated for the QC level 1 ranged from 4.92 to 6.20 across all equipment, while for the QC level 2 Six Sigma varied from 4.87 to 7.59. All values found were classified as Good, Excellent and World Class according to the normalized method decision chart. These results showed that analytical performance of all eight modules of Atellica IM were similar in terms of random and systematic error. Conclusions Six Sigma serves as potent tool for monitoring the analytical performance of the TSH test. It is crucial to independently track different levels of QC in TSH testing for enhanced control over the analytical system. The performance of Siemens TSH test in our laboratory has proven to be very satisfactory.

Measurement uncertainty in clinical chemistry: ISO 20914 versus nordtest or intermediate precision versus bias

Aim Measuring uncertainty (MU) is crucial to ensure the accuracy and precision of laboratory results. This study compares the ISO 20914 and Nordtest guidelines to analyze the MU values for 20 clinical chemistry analytes over six months. Methods The researchers calculated MU components, including within-laboratory reproducibility (Rw), laboratory analytical performance bias (u(bias)), and combined standard uncertainty (u c), based on internal quality control and external quality assessment data. The final expanded uncertainty (U) values were determined by multiplying the combined uncertainty with a coverage factor (k = 2 for 95% Confidence Interval), following each guideline’s respective procedures. Clinical chemistry analytes were analyzed on Roche Cobas 6000 c501 auto analyzer (Roche Diagnostics, Mannheim, Germany) and manufacturer’s kits were used analysis. Results The results show that 11 out of 20 clinical chemistry analytes met the targeted maximum allowable measurement uncertainty (MAU) values when calculated according to ISO 20914 guideline. Also, 11 out of 20 clinical chemistry analytes’ MU values met the MAU values with the Nordtest guideline’s recommended calculations. However, some tests met the MAU in the ISO 20914 approach but not in the Nordtest guideline, and vice versa. Conclusions The study found that intermediate precision (u Rw) in the ISO 20914 approach and performance bias (u(bias)) in the Nordtest approach significantly impacted MU values. The research highlights the importance of standardization in MU calculation approaches across clinical laboratories. These findings have implications for patient care and clinical decision-making, emphasizing the importance of selecting appropriate laboratory guidelines for routine use.

Taxation and Forensic Accounting: Informing Research and Practice

ABSTRACT We synthesize academic research, court cases, and Internal Revenue Service directives related to taxation and forensic accounting to improve the understanding of the extant literature on central issues. We emphasize areas where there is a need for future research opportunities that will contribute to the literature in taxation and forensic accounting. We identify research opportunities in taxation and forensic accounting in critical areas, such as (1) tax issues in business valuation; (2) indirect methods of reconstructing taxable income, including tax fraud and evasion; (3) corporate culture and ethical issues; (4) fraud in tax factors of performance, risk, and disclosure; and (5) internal control and tax assessment. Generally, we find research on taxation and forensic accounting to be scant. This space creates an emerging venue for future research.

A-195 The Application of Six Sigma Metrics to Assess Quality Control of Syphilis Tests in a Clinical Laboratory

Abstract Background Clinical laboratories use quality control processes to monitor and evaluate analytical performance in terms of precision and bias. The periodic measurement of those parameters plays an important role in patient safety and it is a requirement in most accreditation organizations. In recent years, Six Sigma metrics has become one of the most efficient tools to monitor the analytical performance of clinical laboratory systems, since it unifies Total Allowable Error (TEa), random and systematic errors in a single index. However, for many analytes, TEa is not available in the literature based on effect of analytic performance on clinical outcomes or in biological variation. In this case, the TEa must be derived from the “state of art”. In this work, it will be described how Six Sigma was established in our laboratory for Syphilis, with TEa derived from external quality assessment program. Methods A year worth of data was gathered from internal quality control and external quality assessment evaluation to assess the imprecision (in terms of coefficient of variation—CV%) and bias for Syphilis tests processes in four modules of Alinity I (Abbott). Data was split into two groups: “Non-reactive” and “Reactive”. TEa was calculated from the external quality assessment for both groups, based on the median CV% of the peer group evaluated in the last 2 years. Six Sigma metrics were calculated from TEa, CV% and bias for each equipment, using the formula Sigma = (TEa-bias)/CV%. Results TEa for “Non-Reactive” and “Reactive” levels were estimated at 44,25% and 17,7%, respectively. Six Sigma values calculated for “non-Reactive” level were between 4,6 to 5,38 in every equipment. For “Reactive” level, calculated Six Sigma ranged from 4,24 to 5,82. All values found were classified as Good and Excellent according to the Normalized method decision chart. Conclusion Six Sigma is a powerful tool to monitor the analytical performance of the exam. For Syphilis, it is important to monitor “Non-Reactive” and “Reactive” levels separately for a better control over the analytical system. Abbott’s Syphilis test has also a satisfying performance in our laboratory. Also, estimating the TEa from external quality assessment programs is a good alternative for analytes with no quality specifications available in the literature.

Expert assessment of internal quality control and safety of medical activities of nursing staff

Current practice shows that internal quality and safety control of medical activities, being a mandatory licensing requirement, should serve as a tool for self-control and quality and safety management of medical activities and contribute to the continuous development and improvement of the medical organization. Aim. To substantiate the system of internal control of quality and safety of medical activities in the conditions of a modern medical organization. Results. The current system of quality and safety control of medical activities in the organization is analyzed; patient satisfaction with the qualit y and safet y of medical care is examined. Conclusion. The introduction of a quality control system for the provision of medical care has improved the economic performance of the medical organization.

Implementasi Pengendalian Intern Standar Sarbanes-Oxley Act (SOA) Pada Perusahaan Telekomunikasi

The Sarbaness-Oxley Act (SOA) was issued to protect the interests of investors by creating good corporate governance and accountability within the company. SOA, especially sections 302 and 404, require an annual management report regarding the company's internal control over financial reporting and the management report is the subject to be audited. This study describes the implementation of SOA at PT Telkom, Tbk, because PT Telkom, Tbk is one of the Indonesian companies listed on the stock exchange in the United States (NYSE) so that PT Telkom must comply with SOA as required by the SEC. The research was conducted by comparing SOA theory or standards with SOA practices that occurred at PT Telkom, Tbk. The results of the research show that PT Telkom has implemented SOA provisions. And from the results of research conducted in the Finance Section of PT. Telkom Yogyakarta shows that increased transparency and regulation of the audit industry that encourages the effectiveness and independence of auditors is needed to maintain and increase investor confidence in the capital market. SOA Implementation at PT. Telkom, especially concerning section 302 (Corporate responsibility for financial reports) and section 404 (Management assessment of internal controls) is expected to provide benefits to the company in realizing Good Corporate Governance (GCG). With Good Corporate Governance, the transparency of PT. Telkom as a public company will be even more real

The Impacts of Internal Audit Practices on the Quality of Internal Control in Vietnamese Smes

Purpose: This study examines the impacts of internal audit practices on internal control in Vietnamese SMEs. Theoretical framework: This paper employs the three lines of defense model framework to study the impact of internal audit practices on internal control in Vietnamese SMEs. Internal auditing practices were measured by the items listed in the attribute standards and performance standards of the International Professional Practices Framework (IPPF). Internal control quality includes control environment, risk assessment, control activities, information and communication, and monitoring which are provided by the Committee of Sponsoring Organizations of the Treadway Commission (COSO) Framework. Design/methodology/approach: We collect primary data using questionnaire. Data collected from the questionnaire is divided into two groups (1) the measurement of the internal auditing practices and (2) the measurement of the quality of internal control system. We then use the Structural Equation Modelling (SEM) to test for the hypotheses related to the relationship between internal audit practices and internal control. Findings: Our results suggest that both attribute standards and performance standards have positive impacts on the control environment, risk assessment, control activities, and monitoring aspects of internal control. Meanwhile, internal audit seems to not influence the information and communication. Research, Practical & Social implications: The study contributes to the literature by shedding light on the impacts of internal audit practices on the quality of internal control in Vietnamese SMEs. Originality/value: This study examines the unique context of Vietnamese SMEs. Ultimately, the framework aims to provide a comprehensive understanding of how internal audit practices impact internal control quality in this specific context.

Инструментальные методы и их применение во внутреннем финансовом контроле и аудите бюджетного учёта и отчётности

Budgetary sphere is subject to the risks of budget accounting and reporting violations, which managers and accountants face. To reduce risks and confirm accuracy of accounting and reporting, modern control and audit tools are used at the level of departments and institutions. Internal control and audit in recent years are constantly being reformed and transformed on the basis of goals and objectives. Federal standards are used to regulate internal financial audit, and normative base for internal financial control is far from being perfect and is not very clear in practice. In this regard, there are many discrepancies, interpretations and understanding of organization of these types of control in institutions. The purpose of the study is to compare internal financial control and audit in the public sphere, substantiate the unity and opposite of the control purpose and describe verification methodology and the tools. The research methodology is based on application of monographic research methods, discussion, analysis of normative base, economic substantiation of the provisions of departmental regulations in the field of control and audit, comparative assessment of internal financial control and audit. As a result, comparative assessment of internal financial control and audit is given, and the relationship between internal financial control and audit is demonstrated. This relationship can be traced through the purpose of these types of control. The importance of methods, ways and techniques of control and audit as components of the tools of the controller and auditor is substantiated. It is shown which methods are used in practice by internal auditors, and which are used by internal controllers, and what methodological and instrumental relationship is between them.

Внутренний финансовый контроль за достоверностью финансовой отчётности государственных (муниципальных) учреждений

At present internal financial control is an effective tool to improve quality of financial management in the public sphere. The reliability assessment of internal financial control is carried out in the process of internal financial audit and is an independent process of execution ensuring of budgetary powers during budget formation and performance, fulfillment of state tasks and disbursement of allocated funds. The formation problems of the system of internal financial control in the state (municipal) institutions are currently relevant. A number of normative regulations in the field of internal control were abolished and recommendations for accounting processes control were introduced, which significantly narrow the scope of control and lead to violations and errors. The purpose of the study is to develop theoretical, methodological and practical aspects of organization and conduct of internal financial control of state (municipal) institutions to confirm the reliability of financial statements, transparency and correctness of budget process, and the legality of budget procedures. Abstract-logical method, discussion method, normative-legal study, methods of comparison, matching technique, hypothetical assumption, grouping method and the author's expert assessment of the current state of the issue were used in the article to study the multidimensional problems of internal financial control. As a result, the assessment of the main local acts in the field of internal financial control is given, the necessity and practical examples of data control automation processes are substantiated, components of the internal financial control system in a public institution are considered, methods and procedures of internal financial control are summarized, and control actions are proposed to confirm financial statements reliability.

The Role of Internal Audit Computerization in Supporting the Task of External Auditing in Jordanian Insurance Companies

The study aimed to examine the role of the computerization of internal audits in Jordanian insurance companies in supporting the tasks of the external auditor. The study population consisted of managers and heads of internal audit departments, a number which is estimated at 112 in Jordanian insurance companies, of which there were 25 in the year 2021. Using a questionnaire as a primary source for the study data and relevant statistical methods to analyze the respondents’ answers, it is concluded that there is a significant impact for the computerization of internal auditing processes in supporting the tasks of external auditing, and that the computerization of internal auditing processes has a statistical impact on supporting risk assessment, internal control assessment, and the evaluation of audit evidence by the external auditor. The study recommended giving more attention to qualifying both external and internal auditors to work considering the widespread computerized environment, as well as conducting similar studies in different sectors to compare the results from other sectors with those from the Jordanian insurance companies’ sector in this study.

Monitoring and analysis of the effectiveness of internal control of a commercial organization

The author of this scientific work analyzed the key mechanisms associated with the internal control process used in Russian and foreign practice. Based on the fact that the word "control" is interpreted differently in Russian and foreign practice, the author proposed his own definition of internal control, based on a combination of elements from the existing definitions of the concept under consideration. Internal control in the organization is divided into financial, economic, economic, as a result of which this process acts as a complex phenomenon. The main principles of economic control defined in the regulations were considered. In addition, all the methods used by internal control can be divided into methods of actual control and methods of documentary control. In Russian practice, a broad classification of internal control is carried out by the time of implementation, by completeness of coverage, by frequency, in relation to the audited organization. Among the normatively fixed elements of internal control, the control environment, risk assessment, internal control procedure, information and communication, and assessment of internal control stand out. The author established the relationship between the types of economic control, namely organizational and technical, administrative and financial, and the forms of control, which include thematic verification, revision, audit and accounting verification. The paper considers the key foreign concepts of internal control, which include COSO, COBIT, SAC, SAS/ISA. The author highlighted the similarities and differences between these approaches, during which it was revealed that basically all the concepts of internal control differ from each other in the object of observation.

Contemporary evaluation of estrogen receptor and progesterone receptor expression in breast cancer-associated stroma.

To investigate nuclear estrogen receptor α (ERα) and progesterone receptor (PR) immunohistochemistry (IHC) patterns in the stroma surrounding invasive carcinoma and assess associations with clinicopathologic features. A retrospective database search (1/2017-12/2020) identified breast core biopsies with invasive carcinoma. ERα/PR IHC expression in invasive carcinoma and stromal cells was categorized visually as positive (> 10%), low positive (1-10%) or negative (< 1%). Tumors were divided into 4 subtypes by IHC: Luminal, Luminal HER2, HER2 enriched, and triple negative. Clinicopathologic features associated (univariate p-value < 0.15) with ERα/PR stromal expression were investigated further using stepwise multivariable logistic regression. Of 1512 biopsies, 1278 had accessible IHC. 55.6% (711/1278) and 10.4% (133/1274) of cases showed cancer-associated stromal fibroblast expression of ERα and PR, respectively. Stromal ER positivity was significantly associated with use of the Ventana (with SP1 clone) versus Leica (with 6F11 clone) platform and in cases with Luminal cancer subtype. PR stromal expression was significantly associated with Luminal subtype, obesity, and younger age. Expression of ERα and PR in breast cancer-associated stroma showed associations that suggest both biologic and analytic influence. Reproducible expression patterns may inform expansion of ERα/PR guidelines for the assessment of internal controls.

A practical approach example to measurement uncertainty: Evaluation of 26 immunoassay parameters.

IntroductionMeasurement uncertainty is a non-negative parameter that characterizes the distribution of all values appropriate to the measured size and is associated with the measured result. In this study, we aimed to compare the results with various suggestions and produce more qualified results by calculating the measurement uncertainties of the immunoassays like fertility hormones, drug concentration tests, cardiac markers, thyroid function tests and tumour markers.Materials and methodsUncertainty calculation was made in accordance with the top-down approach according to Nordtest guide. The 12-month study of internal and external quality assessment results were used. The parameters of drug concentration tests were performed on the Abbott Architect c8000, other hormones/markers on the i2000 of the same brand.ResultsFactors that increased the measurement uncertainty of a test were due to external quality control data. The calculations showed that 13 of 26 parameters satisfied quality requirements. The highest uncertainty value, with 28% belonged to cancer antigen 19-9 test. The lowest value was calculated for prolactin with 8.3%. Dehydroepiandrosterone sulfate and phenytoin performed poorly in terms of measurement uncertainty, although internal and external quality control assessment results were considered favourable for both.ConclusionIt is recommended that the concept of measurement uncertainty, which plays an important role in the total quality performance of the laboratory, should be followed up by the clinical laboratory experts at certain time intervals and should be increased the awareness of clinicians about the subject.

Assessment of Internal Quality Control of Blood Products; Experience at a Regional Transfusion Centre from Northern Pakistan

Objective: To analyze internal quality control of blood components, including red cell concentrates, fresh frozen plasma, cryoprecipitate and random donor platelets, to measure our blood bank performance.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan from Jul to Dec 2021.&#x0D; Methodology: Whole blood units were separated into red cell concentrates, fresh frozen plasma and random platelets by the platelet-rich plasma method. Cryoprecipitates were prepared from FFPs. Quality control was done on representative components. For red cell concentrates, hematocrit was measured. For platelet concentrates, pH and platelet yield were measured. For fresh frozen plasma, Factor-VIII assay and for cryoprecipitate, Factor VIII and fibrinogen assays were done. The blood components were also tested for bacterial cultures.&#x0D; Results: A total of 1130 units were analyzed for quality control, including 360 red cell concentrates, fresh frozen plasma, random donor platelets each and 50 cryoprecipitates. Red cell concentrates had a mean hematocrit of 68.5±3.7%. Random donor platelets had a yield of 10.1±1.4× 1010 / unit and a mean pH of 6.7±0.2. Fresh frozen plasma had a Factor VIII level of 2.2±0.98 IU/ml. Cryoprecipitate had a mean fibrinogen level of 202.8±27.8 mg/unit and Factor VIII132.5±54.1IU/unit. All blood components met internal quality control standards. Blood cultures were negative in 99.2% of random donor platelets tested.&#x0D; Conclusion: The internal quality control of blood products was in concordance with the national and international standards for quality control in blood banks.

Flowing through laboratory clinical data: the role of artificial intelligence and big data.

During the last few years, clinical laboratories have faced a sea change, from facilities producing a high volume of low-cost test results, toward a more integrated and patient-centered service. Parallel to this paradigm change, the digitalization of healthcare data has made an enormous quantity of patients' data easily accessible, thus opening new scenarios for the utilization of artificial intelligence (AI) tools. Every day, clinical laboratories produce a huge amount of information, of which patients' results are only a part. The laboratory information system (LIS) may include other "relevant" compounding data, such as internal quality control or external quality assessment (EQA) results, as well as, for example, timing of test requests and of blood collection and exams transmission, these data having peculiar characteristics typical of big data, as volume, velocity, variety, and veracity, potentially being used to generate value in patients' care. Despite the increasing interest expressed in AI and big data in laboratory medicine, these topics are approaching the discipline slowly for several reasons, attributable to lack of knowledge and skills but also to poor or absent standardization, harmonization and problematic regulatory and ethical issues. Finally, it is important to bear in mind that the mathematical postulation of algorithms is not sufficient for obtaining useful clinical tools, especially when biological parameters are not evaluated in the appropriate context. It is therefore necessary to enhance cooperation between laboratory and AI experts, and to coordinate and govern processes, thus favoring the development of valuable clinical tools.

Applying ISA 240 for Fraud Detection and Resolution: Evidence from Indonesia and Ghana

ABSTRACT Prior studies in developed countries investigate the auditor's fraud detection process. However, it is unclear whether the results from developed countries apply in developing countries because no fraud detection research has been performed in this setting. The current study examines how auditors in two developing countries, Indonesia and Ghana, apply ISA 240 for fraud detection, including how auditors identify, investigate, and resolve potential fraud issues. We find that (1) senior managers originate most asset misappropriation frauds; (2) auditors in Indonesia and Ghana do not use information technology or internal control assessment for fraud investigation; (3) auditors modify the audit program once potential fraud is detected; and (4) auditors use a more contending than conceding negotiation strategy when resolving potential fraud issues, which often stop short of requiring audit clients to record all audit adjustments. Data Availability: Contact the authors. JEL Classifications: M42.

Determination of Sigma metric based on various TEa sources for CBC parameters: the need for Sigma metrics harmonization

Abstract Objectives The application of Sigma metrics can be used for assessing the performance of diagnostic laboratories. Clinical laboratories are confronted with the trouble of having to select the best and suitable quality specifications that are required for quality planning. In this regard, our study aims at evaluating the performance of Sysmex XN-1000 hematology analyzer by using Sigma metrics based on different total allowable error (TEa) source and to determine the effects of these variations in Sigma metric evaluation. Methods Five TEa requirements were selected to calculate Sigma metrics of 11 complete blood count (CBC) parameters. Coefficient of variation (CV) and bias data were supplied from internal quality control (IQC) and External Quality Assessment Scheme (EQAS) respectively. Results According to TEa based on desirable biological variation (BV) database specifications, the highest Sigma value was achieved by white blood cell count for each level, the lowest value was achieved by Red Cell Distribution Width-Standard Deviation parameter. The Sigma calculation based on Spanish TEa showed that seven CBC parameter achieved Sigma value ≥3. Conclusions According to the results of the study, it can be concluded that Sigma scores have a significant fluctuation based on which TEa sources are utilized and the need for Sigma metrics harmonization and standardization is highlighted. Additionally, low Sigma values of most CBC parameters are resulted in the conclusion that the use of performance goals depending on BV data is difficult for common clinical use. Therefore, clear standardized criteria are quite necessary for the selection of TEa goal by laboratories.

Expert assessment of internal quality control and safety of medical activities of nursing staff in SBHI «Penza regional clinical hospital named after N. N. Burdenko»

aim of the study is to develop a scientifically based unified system of internal quality control and safety of medical activities. Results. The current system for assessing nursing staff is that, as a result of the assessment, conclusions can be drawn for the employee’s self-development, for developing his necessary competencies, improving relations with colleagues, and decisions are made on training, advanced training of the employee, promotion or demotion. Conclusion. In modern conditions, the labor The assessment system should become one of the main objects of personnel management. The development of effective methods and models of personnel assessment becomes a necessary factor in the activity of a medical organization.

Applicability of the long-term uncertainty in measurement (LTUM) method for analytical performance assessment in clinical cytometry laboratories.

BackgroundThe estimation of uncertainty in measurement for quantitative analyses is an international obligation of the ISO15189 standard for laboratories. The most widespread method is the Internal Quality Control and External Quality Assessment (IQC + EQA).MethodsWe compared two methods to assess uncertainty in measurement for the quantification of the number of CD34+ stem cells and of the different lymphocyte subpopulations in blood samples: the IQC + EQA method and the Long‐Term Uncertainty in Measurement (LTUM) method.ResultsWe focused on the CD3+/CD4+ T lymphocyte subpopulation for a target value of 350 CD3+/CD4+/μl. The range in terms of uncertainty in the measurement of 350 CD3+/CD4+ cells/μl with the IQC + EQA method was [292.8; 407.2]. With the LTUM method, the uncertainty was 19.1% of the measured value. This represented a range of [283.2; 416.9].ConclusionsThe relative uncertainty calculated with the LTUM method can be adapted to any level of the measured parameter. IQC and EQA calculate the absolute uncertainty and need a clustering of values at different levels. This clustering can lead to some approximations in the uncertainty in measurement determination, particularly around the cut‐off values. Unlike previous reports, uncertainty values were higher when calculated with the LTUM than with the IQC + EQA method. However, LTUM might be more representative of the daily routine practice with patient samples.

Moving average procedures as an additional tool for real-time analytical quality control: challenges and opportunities of implementation in small-volume medical laboratories.

IntroductionMoving average (MA) is one possible way to use patient results for analytical quality control in medical laboratories. The aims of this study were to: (1) implement previously optimized MA procedures for 10 clinical chemistry analytes into the laboratory information system (LIS); (2) monitor their performance as a real-time quality control tool, and (3) define an algorithm for MA alarm management in a small-volume laboratory to suit the specific laboratory.Materials and methodsMoving average alarms were monitored and analysed over a period of 6 months on all patient results (total of 73,059) obtained for 10 clinical chemistry parameters. The optimal MA procedures were selected previously using an already described technique called the bias detection simulation method, considering the ability of bias detection the size of total allowable error as the key parameter for optimization.ResultsDuring 6 months, 17 MA alarms were registered, which is 0.023% of the total number of generated MA values. In 65% of cases, their cause was of pre-analytical origin, in 12% of analytical origin, and in 23% the cause was not found. The highest alarm rate was determined on sodium (0.10%), and the lowest on calcium and chloride.ConclusionsThis paper showed that even in a small-volume laboratory, previously optimized MA procedures could be successfully implemented in the LIS and used for continuous quality control. Review of patient results, re-analysis of samples from the stable period, analysis of internal quality control samples and assessment of the analyser malfunctions and maintenance log have been proposed for the algorithm for managing MA alarms.