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Use of quality indicators by clinical bacteriology laboratories in Ontario, Canada – External quality assessment survey by Quality Management Program–Laboratory Services

Abstract number: P1374

Fleming C., Toye B., Jamieson F., Meaney H., Poutanen S., Rutherford C., Sarabia A., Gun-Munro J., Flynn G.

Objective: To assess current practice on the use of quality indicators (QIs) by bacteriology labs in Ontario.

Methods: Quality Management Program–Laboratory Services is a mandatory external quality assessment (EQA) and accreditation program for clinical labs in Ontario. As part of the microbiology EQA program, the 104 Ontario labs licensed for bacteriology in June 2007 were required to complete a questionnaire on QIs monitored in the past five years and categorise each QI as pre-analytic, analytic or post-analytic. Labs occasionally incorrectly categorised the phase of the testing process being monitored and these results were appropriately reclassified. For those QIs monitored in the previous 12 months, labs were asked to provide details on data collection, target values and whether these had changed over time, results of monitoring and corrective actions undertaken.

Results: The 104 labs reported monitoring a total of 947 QIs over the five years (mean: 9; median: 9; range: 0–22). Specimen rejection rate (n = 31), blood culture contamination rate (n = 38), blood culture volume (n = 35), transit times (n = 31) and number of blood culture sets (n = 39) were the most common pre-analytic QIs. Results review prior to report release (n = 35) and correlation of Gram stain results with culture (n = 3) were the most frequently reported analytic QIs. Report turnaround time (TAT) for CSF (n = 39) and blood culture (n = 30) Gram stains and review of reported results for transcription errors (n = 36) were the most common post-analytic QIs. 125/947 (13%) of the QIs reported by labs were deemed to be erroneous QIs (e.g. quality control, temperature monitoring of equipment). Labs reported compiling data manually for most QIs. Not all labs had established target values for their QIs and some of the values reported were not well-defined (e.g. reduce specimen rejection). Only 6% of the target values had been revised over time. Corrective actions implemented as a result of monitoring QIs were variable and not all were appropriate.

Conclusion: The use of QIs by bacteriology labs is widespread in Ontario. Nevertheless, this survey identified a lack of understanding of QIs by some labs as evidenced by misidentifying basic QC as a QI, lack of targets or thresholds for some QIs and the need to revise targets over time in order to effect process improvement. QMP–LS released a summary of these findings to Ontario labs along with educational commentary to assist labs in improving their quality systems.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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