Monday, July 23, 2012

Laboratory Performance 2012 - a warning

I have been tracking Proficiency Testing performance in laboratories for a long time, but most objectively over the last 10 years.  I presented this information a year ago, and I am presenting it again, updated by another year.  

What the information says is that as the size and complexity of the laboratory gets smaller (category A is the most complex and category C1 is the least) the laboratories performance on PT challenges gets poorer.  This is true year over year and is magnified because the larger laboratories get more samples with more diversity and more complexity and the smaller laboratories get samples that are less diverse and less complex.  

Now I understand that performance on proficiency testing is not the sole, nor necessarily the best indicator for clinical laboratory performance, but I will argue that it is a very good proxy.  While good PT performance does not necessarily ensure good clinical performance, less good performance reflects problems, often of a systematic or structural nature.  If a laboratory does not perform well on samples that closely simulate typical clinical samples (and across Canada, that is the norm) it is a cautionary flag that clinical performance may be suffering as well.  

And that is why having a low percent achieved score on PT challenges is a problem that should be monitored and addressed.

I have argued in the past, over and over and over, that the system is stacked against the smaller laboratory because they have fewer staff, less direct supervision, and less time and resources for continuing education, and little support at key levels.  

But this year starts to see a new trend in a number of provinces where this problem takes on a new urgency.  Health care across Canada is both broken and broke.

As the developed world struggles to find the elusive financial recovery, all jurisdictions are cutting back.  We use all sorts of positive euphemisms such as “doing better with less” and “innovative restructuring” but the public healthcare system is losing staff at every level, and much more emphasis is being put on home care. 

Frankly I don’t personally see that as all problematic.  Hospital care was never that special anyways and we have all become really aware of how much damage we do in hospital care with unwashed hands, deteriorating cleanliness, and less than optimal nutrition.  So if you have someone at home, or can arrange to have someone at home, to provide recuperative and longer term homecare service, that is probably a good thing.  

Back in the eighties (now some twenty-five years ago!) the mantra was “closer-to-home”.  Now it is becoming “in-the-home”.

But as folks go home it means that they live further away from the big facilities with the big laboratories with all their resources.  Folks are at home and much closer to the smaller laboratories.  Smaller laboratories are finding their work load is going up, and their complexity is going up.  Now they are seeing samples from patients that they have not seen for a long time.  But the problem is that if they were under-equipped for small volume low complexity work, they are in a worse position now.  

A colleague of mine has recently taken on the challenge of providing the additional support and supervision for the smaller laboratories in his province.  And that is a good thing.  If that does not become the norm then you can predict that the support system for home care will flounder and that will only make a weak situation much worse. 

So here is the message:  Healthcare collapsing; homecare arising.  Get help for the small “closer-to-home” laboratories or suffer the consequences.  

The full CMPT annual report will be out and available in early October.  You can read last year’s report at

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