Evaluation of Key Performance Indicators in the Pre-analytical Phase of Testing in a Clinical Chemistry Laboratory of a Reference Institute
DOI:
https://doi.org/10.51253/pafmj.v73i6.8556Keywords:
Key performance indicators, Pre-analytical error, Six sigmaAbstract
Objectives: To check the performance in the pre-analytical phase of testing in the clinical chemistry laboratory of a reference institute using five key performance indicators and to compare these indicators between the morning and night shifts to ascertain the most probable source of pre-analytical errors.
Study Design: Comparative cross-sectional study
Place and Duration of Study: Department of Chemical Pathology & Endocrinology, Armed Forces Institute of Pathology
(AFIP), Rawalpindi Pakistan, from Apr to Sep 2021.
Methodology: Defined key performance indicators (KPIs) were observed for a period of six months. The frequency and
percentage of each KPI were calculated. Defects per Million were calculated for deriving Six Sigma (σ) values. KPIs were also
compared between the morning and night shifts.
Results: A total of 272,731 samples were observed in which 2306(0.84%) were found haemolysed (σ=3.5), 604 samples (0.22%) were not received in the Department due to various pre-analytic reasons (σ=4.0), 260 samples (0.09 %) were found having insufficient sample volume for analysis (σ=4.5), 181(0.06%) samples were found having improper/ wrong labelling or bar code errors (σ=4.5) and 161(0.05%) samples were delivered in wrong tubes (σ=4.5). KPI-1, KPI-2, and KPI-3 were found to be significantly higher during the night shift than the morning shift.
Conclusion: Haemolysed samples and lost-not-received samples were the main causes of pre-analytical errors Key
performance indicators aided as an instrument to screen and improve process execution in the laboratory.
Downloads
References
Dilworth LL, Mc Growder DA, Thompson RK. Identification of
pre-examination errors in the chemical pathology laboratory at
the university hospital of the West Indies. Indian J Clin Biochem
; 29(2): 227-231. https://doi.org/10.1007/s12291-013-0348-6
Plebani M. Errors in clinical laboratories or errors in laboratory
medicine? Clin Chem Lab Med 2006; 44(6): 750-759.
https://doi.org/10.1515/cclm.2006.123
Sciacovelli L, Plebani M. The IFCC Working Group on laboratory
errors and patient safety. Clinica Chimica Acta 2009 ; 404(1): 79–
https://doi.org/10.1016/j.cca.2009.03.025
Maheshchandra Rana N, Dalpatbhai LAD H, Manoj Kathiria U,
Ramavataram D. Evaluation of laboratory performance in
consideration with quality indicators and rectification measures
at clinical biochemistry laboratory. Int J Clin Biochem Res 2019 ;
(1): 67–73. https://doi.org/10.18231/2394-6377.2019.0018
Chawla R, Goswami B, Singh B, Chawla A, Gupta VK, Mallika V,
et al. Evaluating Laboratory Performance With Quality
Indicators. Lab Med 2010; 41(5): 297–300.
http://doi.org/10.1309/LMS2CBXBA6Y0OWMG
Lippi G, Giavarina D, Montagnana M, Luca Salvagno G,
Cappelletti P, Plebani M, et al. National survey on critical values
reporting in a cohort of Italian laboratories. Clin Chem Lab Med
; 45(10): 1411-1413. https://doi.org/10.1515/cclm.2007.288
West J, Atherton J, Costelloe SJ, Pourmahram G, Stretton A,
Cornes M, et al. Preanalytical errors in medical laboratories: a
review of the available methodologies of data collection and
analysis. Ann Clin Biochem 2017; 54(1): 14–19.
https://doi.org/10.1177/0004563216669384
Patel S, Nanda R, Sahoo S, Mohapatra E. Congruity in Quality
Indicators and Laboratory Performance. Indian J Clin Biochem
; 33(3): 341–347. https://doi.org/10.1007/s12291-017-0687-9
Hawkins R. Managing the pre- and post-analytical phases of the
total testing process. Ann Lab Med 2012; 32(1): 5–16.
https://doi.org/10.3343%2Falm.2012.32.1.5
Akan ÖA, Elmali E, Karaeren Z. Evaluation of Preanalytic Errors
in Clinical Laboratory Practice. Lab Med 2006; 37(8): 478–480.
http://dx.doi.org/10.1309/0CA5NJTCKM6N10RE
Shahangian S, Snyder SR. Laboratory medicine quality
indicators: a review of the literature. Am J Clin Pathol 2009;
(3): 418–431. https://doi.org/10.1309/ajcpjf8ji4zldque
Cao L, Chen M, Phipps RA, Del Guidice RE, Handy BC, Wagar
EA, et al. Causes and impact of specimen rejection in a clinical
chemistry laboratory. Clin Chim Acta 2016: 458(1): 154-158.
https://doi.org/10.1016/j.cca.2016.05.003
Jafri L, Khan AH, Ghani F, Shakeel S, Raheem A, Siddiqui I, et al.
Error identification in a high-volume clinical chemistry
laboratory: Five-year experience. Scand J Clin Lab Invest 2015;
(4): 296–300. https://doi.org/10.3109/00365513.2015.1010175
Westgard JO, Westgard SA. The quality of laboratory testing
today: an assessment of sigma metrics for analytic quality using
performance data from proficiency testing surveys and the CLIA
criteria for acceptable performance. Am J Clin Pathol 2006;
(3): 343–354.
Kulkarni S, Ramesh R, Srinivasan AR, Silvia CRWD. Evaluation
of Preanalytical Quality Indicators by Six Sigma and Pareto`s
Principle. Indian J Clin Biochem 2018; 33(1): 102–107.
https://doi.org/10.1007/s12291-017-0654-5
Hens K, Berth M, Armbruster D, Westgard S. Sigma metrics used
to assess analytical quality of clinical chemistry assays:
importance of the allowable total error (TEa) target. Clin Chem
Lab Med 2014 Jul; 52(7): 973-980.
https://doi.org/10.1515/cclm-2013-1090
Rooper L, Carter J, Hargrove J, Hoffmann S, Riedel S. Targeting
Rejection: Analysis of Specimen Acceptability and Rejection, and
Framework for Identifying Interventions in a Single Tertiary
Healthcare Facility. J Clin Lab Anal 2017; 31(3): e22060.
https://doi.org/10.1002/jcla.22060
Grecu DS, Vlad DC, Dumitrascu V. Quality indicators in the
preanalytical phase of testing in a stat laboratory. Lab Med 2014;
(1): 74–81. https://doi.org/10.1309/lm9zy92ybzrfpfqy
Astion ML, Shojania KG, Hamill TR, Kim S, Ng VL. Classifying
laboratory incident reports to identify problems that jeopardize
patient safety. Am J Clin Pathol 2003; 120(1): 18–26.
https://doi.org/10.1309/8exc-cm6y-r1th-ubaf
Wiwanitkit V. Types and frequency of preanalytical mistakes in
the first Thai ISO 9002:1994 certified clinical laboratory, a 6-
month monitoring. BMC Clin Pathol 2001; 1(1): 5-8.
https://doi.org/10.1186/1472-6890-1-5
Plebani M, Sciacovelli L, Marinova M, Marcuccitti J, Chiozza ML.
Quality indicators in laboratory medicine: A fundamental tool
for quality and patient safety. Clin Biochem 2013 ; 46(13–14):