Experience with an alternative form of samples for external quality assessment of urinary sediment (visual sample EQA).

BACKGROUND: Urinary sediment components are mainly unstable, especially in their original forms. This makes the use of such material in routine external quality assessment surveys (EQAS) almost impossible. The development of an alternative EQAS for urinary sediment using photomicrographs (visual-sample EQAS) is described here, together with results, improvements and future plans. METHODS: The original survey allowed a free-text interpretation, which proved to be time consuming and impractical. The next phase included a multiple choice answer (one from five alternatives). The current version challenges the participant with a list of over 50 alternatives, together with a "not-in-the-list" possibility. RESULTS: Certain elements are always interpreted more correctly (examples: erythrocytes, squamous cells, renal epithelial cells, bacteria--above 90%) than others (examples: leukocytes, fat droplets, certain crystals--below 55%). Pictures are included which are atypical (for example: decoy cells, which must be interpreted correctly, other artefacts). Occasionally interesting structures are included, but which are not evaluated. CONCLUSIONS: The two-dimensional pictures often limited the interpretation possibilities, so that in such cases more than one answer was allowed. The possibility of "online microscopy" using staple pictures is at present in evaluation. The acceptance of this type of EQAS is seen by the number of participants, at present over 500 per survey, four surveys per year.

An educational web-based external quality assessment outcome and evaluation: first experiences with urinary sediment and hemostaseology.

External quality assessment is a standard procedure for many medical laboratories, especially those accredited according to ISO 15189. INSTAND has developed web-based quality control surveys (WQ) with integrated case-based learning in collaboration with the Institute for Teaching and Educational Research in Health Sciences (IDBG), University of Witten/Herdecke. The WQs were presented via a weblink using the learning management system CASUS. Laboratories registered with INSTAND for conventional EQAs covering the same topic were invited to participate in the WQs. Statistics were calculated with the INSTAND EQA-evaluation program and with the "Statistical Program for Social Sciences" (SPSS Version 20). While the two pilot surveys (hemostaseology) were designed for laboratory technicians, WQ III (urine sediment) addressed the whole laboratory team. From the invited laboratories more than 80% participated successfully and the evaluations showed that, in general, more than half the participants solved the tasks as a team. The web-based EQAs were well accepted by the users, with some technical problems in WQ III and moderate criticism on the images and relevance for daily practice in the evaluation sheets. Well above 80% would like to participate in further WQs and would recommend them to other laboratories. Thus web-based quality control surveys can emerge as an important supplement to conventional EQAs.