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Tuesday, March 18, 2014

Does Laboratory Accreditation Improve Patient Safety?



Does Laboratory Accreditation Improve Patient Safety?

Module 3 in our Certificate Course in Laboratory Quality Management is my favorite because it addresses the critically relevant issues of the modern medical laboratory including the Costs of Poor Quality and the Role of Quality Partners.  

For reasons unclear, many (most?) modern laboratorians have brainwashed themselves into disparaging all the groups that have been created to HELP laboratories meet customer requirements.  “We” are suspicious of accreditation bodies, and disparage proficiency testing programs.  “We” trivialize educators, and demean suppliers for being in it only for the money (as if making money is a bad thing!).  I am not sure why we do this.  It has been the order of the day ever since I got involved in laboratory medicine in the 1970s.  But through our course, the evidence for increasing awareness of the importance of Quality through  literature and conferences and activities is very present.  I think that we are recognizing our friends better but it has been a slow process. 

One of the questions that I pose to the group in Module 3 is “Does laboratory accreditation improve patient safety, and how can you prove it?”.

I will say that I come to this question with a point of view.  I wrote an opinion piece now a long time ago [see  Noble MA. Does external evaluation of laboratories improve patient safety? Clin Chem Lab Med. 2007;45(6):753-5] at which time I opined that it is impossible to demonstrate by evidence, but it would be a mistake to stop accreditation just because you can prove it helps patients.  I have also written in this on-line journal [see: http://www.medicallaboratoryquality.com/2013/03/making-your-quality-partner-your-enemy.html and http://www.medicallaboratoryquality.com/2013/03/quality-and-accreditation-partnership_18.html

It is still a relevant question to ask, especially with this group of experienced laboratorians who are sufficiently committed to laboratory quality that they would put a lot of money out and spend a lot of time thinking about and discussing relevant Quality.  

Of note and interest, all participants who engaged in the conversation wanted to believe that accreditation would increase patient safety for all the same and reasonable reasons.

First and second, accreditation would increase the interest in maintaining standards, and accreditation would increase the strength of the Culture of Quality.  Some did a PubMed search and found Peter’s aspirational and speculative  “Impact of Laboratory Accreditation on Patient Care and the Health System” (Am J Clin Pathol 2010) which says but doesn’t demonstrate the relationship.  

One person, wrote that on balance accreditation had more advantages than disadvantages.  That is a great sentence.

One of the challenges to writing more definitive statements is that the value of accreditation is very difficult to prove by study.  We talked about studying laboratories before and after accreditation looking for parameters like turnaround, and error, and report quality, but that sort of study could take years, and even with that looking for those markers would not help.  We talked about going to a native jurisdiction where there is no accreditation and then preparing one group while leaving the other group alone.  Aside from the moral perspective, this approach would likely fail as well because the point of Quality is not so much to stop errors, but to pick them up faster, and that would be very difficult to demonstrate.

All this taken aside, the important first step is that we have a group of laboratorians who believe accreditation is a positive step forward, and to my way of thinking that is indeed the most important step forward.  In this group the scepticism about accreditation is replaced with confidence and trust.  That is brilliant and a huge step forward. 

Now if we can figure out how to block health authority and government and capitalist bean and profit counters who all want to throw out the baby with the bath water and actually kill medical laboratories with “redundancy is bad” insanity, we actually have laboratorians  who have insight and care.

But I have my doubts.

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