Closing the loop on quality.

Closing the loop on quality

To assure quality in the past, we had only to drag out our QC and proficiency test results. In reality, quality control is a single spoke in the quality assurance wheel.

Knowing the myriad factors that can affect the outcome of a laboratory procedure,

we must take appropriate QC measures at all times. What is frequently lacking is the remaining portion of the QA cycle. * Step one. The laboratory QA loop begins when a procedure is ordered. Each lab should have a formal system in place for reviewing the appropriateness of lab requests. Quality assurance then moves on to making sure specimens are properly collected, transported, identified, and prepared for analysis.

Analysis encompasses such classic QC measures as controls, duplicate runs, instrument checks, and delta checks of previous results. We do our best to certify that the results we produce correctly indicate each patient's condition.

However accurate the results, they will be useless unless provided to the physician in a timely and efficient way. For this reason, we monitor result turnaround time. To find out where problems lie, we need a comprehensive turnaround check that covers the entire process, from request through report.

The final and most difficult yet most important part of the loop to evaluate is how effectively laboratory results are put into action - that is, toward improving patient care. If results don't lead to better-quality care, all our efforts are in vain. * Look around. The best way to document quality assurance in your lab is to issue a summary report listing QA activities in which your department participates. It is not sufficient merely to state that you monitor QC. Include follow-up of incident reports, performance appraisals, a random review of specimens. Go outside the lab and take part in organizational rounds, chart review, rounds of nursing units, client surveys, and so on. This cumbersome yet critical component of the quality assurance loop is the crux of the whole operation.

Establish thresholds of performance beyond which corrective action will be taken and documented. If turnaround time is greater than you expected, investigate the reasons for this discrepancy and quickly correct them. The parameters of quality control shouldn't be rigid but need to be modified and adjusted as the situation warrants. * Who is responsible. Quality assurance must be overseen and monitored by the laboratory director, whose name should appear on each lab report. In addition, each laboratory worker must perform his or her duties properly and with the highest degree of quality possible.

Assuring quality is in fact the duty of every worker in a health care institution. Patients faced with a dirty lobby or slow admission process may wonder whether unsanitary or inefficient behavior carries over to the operating suite. The QA loop is a continuous circle of checks, documentation, and more checks.

Unlike other industries, the laboratory cannot afford to consider even the smallest error acceptable. Many defective products can be recalled before they do harm. Diagnostic laboratory tests cannot.

The author is administrator of clinical laboratories at Thomas Jefferson University Hospital, Philadelphia.