A discussion site for folks interested in improving the quality of medical laboratories. Most will be the thoughts and vents of a long time player in the medical laboratory quality from many perspectives, complex and basic laboratories, developed and developing countries, research and new knowledge.
Thursday, November 3, 2016
The Road to Perfect EQA?
WARNING:As I write
this entry, I am wearing my Proficiency Testing hat.Folks interested in laboratory quality, but
not in proficiency testing may find this really boring.If PT/EQA is NOT your thing, that is OK;
please leave NOW.
The annual meeting for the
European Organization for External Quality Assessment for Laboratory Medicine
(EQALM) was an excellent get together for EQA providers.Gradually EQALM is becoming not only the
gathering point for European international EQA providers, but intercontinental
] has already written a nice summary on the meeting.
The theme of this year’s
meeting symposium was The Road to Perfect EQA.That is a pretty good way to celebrate 20 years as a EQA provider group.The presenters tackled 4 topics (a) Commutability
(b) Traceability and (c) Accuracy and (d) the challenge to Homogeneity when internal
reagents cause mischief.All were
interesting and important EQA topics, especially if you are focused on
producing challenges for Chemistry laboratories.(Note: that does not include me).
If I had an issue about what
was presented, it was small but important (at least in my mind). The term commutable
is not a particularly good word for EQA because it has a number of
meanings.It can mean “capable of used
for commuting” or can mean “capable of being exchanged” or lastly “capable of
being converted”.In the context of EQA,
I am pretty sure he was not think about commutability in the context of
transportation.I think the presenter
was intending that EQA samples should be sufficiently similar to clinical samples,
that they can be used as an exchangeable
material in the sense that there are no matrix effects.EQA samples should act like regular
samples.I can live with that, but in
chemistry the term can also mean being converted or degraded to end-products,
so you might say you want the sample to be commutable, but you don’t want it to
be commutable.I think the term is
probably not the best choice.
In our clinical microbiology
program we try to take the sense of being exchangeable with clinical samples a
little further.We make the sample to
contain both host and microbial components, combine pathogenic flora with
background flora, and we try to the extent possible to make our samples look
like and act like clinical samples; the point being that being exchangeable
just for the machine and not for the laboratory workers does not go far enough.
But I have a much bigger
issue with what I see as a major weakness in the symposium.It is about what was not presented.It was far too technical focused and did not
include that the REAL Road to Perfect EQA program is the one that leads laboratories
to want to use and learn from EQA.
In my now near 35 years of
PT/EQA with observations around the world in developed and developing countries,
I have seen almost every variation to EQA experience.Most laboratories still see PT/EQA only as something
that Accreditation requires, or something they just have to do.They either never investigate errors, or
given the opportunity never even look at results.When they have a problem they get picky
beyond picky on interpretation of instructions or provided clinical information
rather than acknowledge that they did not process the sample as required and expected.And sometimes (fortunately not very often
these days) some laboratories use deceptive methods to cheat an answer rather
than risk the challenge.
We even have members from
our own committee who feel compelled to argue against the challenge when they participated
in every part of the selection and preparation process.We have seen laboratories threaten regulatory
action because they felt the challenge was too hard/ too easy/ too costly/ too
The Perfect PT/EQA program
wouldn’t have any of those responses.Instead there would be a deluge of letters “Thank you for helping us
find our system error” or “Many thanks for that interesting challenge.We have incorporated a number of changes to
take that into consideration”, and especially “Many thanks for those
educational and informative critiques.We can’t get along without them”.
OK, maybe I’m a little over
the top, but EQA is an important exercise for all laboratories in all fields;
water, food, medical, construction, electrical.In some areas, detecting errors actually saves lives.
Having laboratories miss the
point of the exercise does no one a service, certainly not to laboratory who
chooses to ignore or deflect opportunities to improve, and most certainly not
the customer who in our case represents patients, clinicians and the community.It is a program of purpose.
So, let me propose to my
PT/EQA and in particular EQALM colleagues, “good-on-ya’” for a symposium well
done and focusing interest on an important side of what we do.But maybe at the next major anniversary (the
25th, or 40th, hopefully we don’t have to wait for the 50th!)
we can have The Road to Perfect EQA – Part B where education and customer focus
also get discussed.
SAVE THE DATE: October 1-3, 2017 POLQM Fall Conference on Medical Laboratory Quality