Quality control under the microscope

Summary

Aim

• To eliminate release of inaccurate chemical pathology test results to clinicians from 20 in 2017/18 to zero in 2019/20.
• To reduce waste of QC material in four pilot laboratory sites from average of 25% to 10% by end of the end of the 2019/20 financial year.
• To increase clinician confidence from 73% to 100% in the reliability of chemical pathology results by December 2020.

Benefits

• Reduce adverse events for patients due to incorrect chemical pathology test results being delivered to clinicians
• Reduction in waste of resources (quality control material, reagents and staff time), used to retest samples due to failed quality control detection in the laboratory.
• Improved efficiencies in managing quality control failures which results in less delays to delivery of patient test results.
• Improved confidence of clinicians and patients in reliability and accuracy of results issued by chemical pathology laboratories.
• Increased positive staff competency, experience and satisfaction in performing high value quality control processes.

Background

In November 2012, NSW Health Pathology was formed bringing together the four previously separate pathology networks in NSW and Forensic and Analytical Science services into one single entity. At the five year mark, the organisation commenced its major transformational change that has seen the merger of the four pathology services into one and removed the separate operating arrangements. The focus now in 2019 is in bringing like services into alignment with statewide approaches that deliver the best services to our customers and patients and bring the benefits of economies of scale and shared approaches.

NSW Health Pathology Chemical Pathology laboratories alone perform 26 million tests per year for the patients of NSW. All of these tests require quality control to validate the accuracy of results. Quality control is a statistical science that underpins the patient sample testing performed by clinical chemistry laboratories. Without QC there would be no confidence in the results being issued by the laboratories. Quality control by definition is reactive, in that it forces a reaction from a staff member to look critically at a QC flag (breach of QC rules) and troubleshoot to confirm necessary actions in line with QC policy and procedures.

Variations across all clinical chemistry laboratories in quality control processes, data collection and procedures in chemical pathology testing have all contributed to patient adverse outcomes, inefficiencies and waste.

Four solutions have been identified for development.

• Develop standardised statewide QC policy and procedures.
• Develop standardised statewide QC training and education framework.
• Develop standardised statewide QC data and governance structure.
• Development of communication pathways.

Implementation

This project has progressed through the initiation, diagnostics, solutions development phases. Current work is underway to finalise the solutions development for endorsement and preparation for implementation. The identified quick wins are currently being trialled within the four pilot sites.

Status

Pre-implementation – Planning for the project is well underway. Clinician and consumer consultation has occurred, and solutions are under development.

Dates

July 2019 – December 2020.

Implementation sites

The project is being piloted at Kogarah, Liverpool Tamworth and Westmead NSW Health Pathology Chemical Pathology Laboratories. The final solutions will be implemented across all 61 NSW Health Pathology Chemical Pathology Laboratories and will be overseen by the chemical pathology clinical stream.

Partnerships

This project has been conducted internal to NSW Health Pathology however advice in regards to findings and development of solutions involves broader consultation with interstate public pathology provides and college representatives to identify learnings and ensure solutions development is evidence based and best practice.

Evaluation

Evaluation methods are being built into solution development by working groups. Current work on the quick win testing has been undertaken with pre-audit and post intervention manual auditing of quality control material usage.

Lessons learnt

• Understand the need to identify sources for baseline data prior to the commencement of projects such as this.
• Complex and siloed legacy IT systems do not allow for ease of access to data and in some cases data is simply not captured.
• Looking at variation of practice on such as large scale requires a focus on a sample of sites that represent the larger make up to work on solutions that will be appropriate. However, broader working groups and consultation is a must to support preparation for future implementation.

Contacts