The use of preanalytical quality indicators: a Turkish preliminary survey study.

OBJECTIVES: The utilization of reliable quality indicators (QIs) proven to be suitable for monitoring and improvement tools is one of the best choices to minimize of the risk of errors in all laboratory processes called as total testing process (TTP). In 2008, a Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) established by International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) developed the Model of Quality Indicators (MQI) complying with requirements of the ISO 15189:2012 standard for laboratory accreditation. They have also been dealing with harmonizing the QIs in most laboratories worldwide since then. The present study was set out to investigate the frequency of using IFCC WG-LEPS' pre-QIs by Turkish laboratories and to assess the conformity of them, by taking into account Turkey's conditions. METHODS: A survey consisting nine questions was applied in 81 laboratories using SurveyMonkey. RESULTS: According to the survey results, most of the laboratories reported they have used pre-QIs in the quality standards of health prepared by Turkish Ministry of Health (MOH). A part of IFCC WG-LEPS' pre-QIs were being utilized by more than 80% of the laboratories, the rest of which only used by 10% of laboratories. CONCLUSIONS: The majority of the medical laboratories have been using the pre-QIs included in the guidelines of Quality Standards prepared by the MOH. The pre-QIs are partially compatible with IFCC WG-LEPS' pre-QIs. The definitions of IFCC WG-LEPS' pre-QIs may also be revised to make them more clear and understandable by IFCC WG-LEPS. The insufficiency of Health Information Management Systems (HIMS) limits the use of pre-QIs proposed by IFCC WG-LEPS. Finally, the education of relevant personnel about the use of HIMS and pre-QIs is very crucial to harmonize and to extend the use of IFCC WG-LEPS' pre-QIs in Turkish medical biochemistry laboratories.

Analysis of Prescribed Critical Values in Istanbul Training and Research Hospital Biochemistry Laboratory: Should Critical Values Be Repeated?

BACKGROUND: Clinically important critical values must be readily available to the clinician. Repeating critical values may cause a delay. In this study, we evaluated the requirement of repeating critical values. METHODS: We extracted initial and repeated critical values and reporting times for a six-month period via the hospital laboratory information management system. Ten parameters from our critical value list (glucose, urea, mag-nesium (Mg++), calcium (Ca++), sodium (Na+), potassium (K+), chloride (Cl-), white blood cells (WBC), platelets, hemoglobin) were evaluated. We assessed whether the difference between the first measurement of the initial critical value and the repeated measurement value exceeded total allowable error (TEa). RESULTS: Repeated critical values of Mg++, Ca++, WBC, platelets, and hemoglobin did not exceed TEa. However, repeated critical values of glucose, urea, Na+, K+, and Cl- did exceed TEa. In addition, parameters such as glucose and urea did not affect the clinical decision although their critical values exceeded the TEa. This study showed that critical values for Na+, K+, and Cl- may need to be repeated. CONCLUSIONS: Each laboratory should assess the requirement of repeating critical values under its own operating conditions and, accordingly, establish and implement a suitable policy.