Quality Improvement Metrics Q1 2018

INTRODUCTION

National Reference Laboratory (NRL), part of Mubadala's network of world-class healthcare providers and managed by LabCorp, continue to  demonstrate our commitment to continuing medical education (CME) for laboratory and other healthcare professionals by participating in  leading healthcare events during the first quarter (Q1) of 2018.

As the largest College of American Pathologists (CAP) and ISO15189:2012 accredited referral laboratory network in the Middle East, NRL focuses on the importance of accreditation and the implementation of international medical laboratory standards.  To that end, we organize, collaborate and participate in seminars and presentations to the wider healthcare community.  Client education provides a platform to share our knowledge of clinical laboratory processes and operational outcomes.  The more knowledgeable clients are about laboratory processes the better they will be able to use their patient’s results to achieve an enhanced level of care.

Table-1 below provides information regarding the events in which NRL both organized and participated during Q1 2018:

Date

Event

Topic

NRL Speaker

5th February

MedLab 2018

The Role of Quality Assurance Programs in Optimizing Laboratory Cost-Management

Faisal Ibrahim, MBA, MT (ASCP),Director - Quality Assurance

5th February

MedLab 2018

Glycated Albumin: More than a Biomarker of Glycemic Control

Dr. Shereen Atef, Consultant Clinical Pathologist

6th February

Obs-Gyne 2018

Frequent Questions asked by Gynecologists to Pathologists Related to Cervical Pathology

Dr. Suhaila Alameeri, Consultant Anatomic Pathologist

6th February

MedLab 2018

Laboratory Dashboards and Performance Management

Gagan Goel, IT Director

6th February

MedLab 2018

Pre-analytical Challenges & Advanced Coagulation Testing

Dr. Jay Murthy, Technical Director

7th February

MedLab 2018

Liquid Biopsy – Introduction and Overview

Dr. Basel Altrabulsi, Chief Medical Officer

7th February

MedLab 2018

Revolution in Bacterial Identification and Microbiology Efficiencies – MALDI-TOF

AlBarah El Khani, Director -Technical Operations

8th February

MedLab 2018

Challenges in the Interpretation of Radiologically Detected Breast Lesions

Dr. Suhaila Alameeri, Consultant Anatomic Pathologist

STRATEGIC QUALITY METRICS

1.Sharing Best Practices

Purpose:

Sharing best practices with other healthcare professionals is a core theme of NRL’s mission. We actively review newly approved and developing technology for our laboratories and we communicate what we learn through our investigations and partnerships. This is a responsibility we have assumed to help educate laboratory professionals, physicians and patients. 

NRL continues to renew  its commitment to raise laboratory quality excellence in the region through collaborations with the following partners: CAP, CLSI, and LabCorp.

As part of the MedLab event, two workshops were organized on February 6th and 7th, 2018 in Dubai  Exhibition Center .

  • Genetics workshop
  • Laboratory accreditation workshop

Over 300  professionals participated in these two day workshops. CME certificates were issued for the attendees.

List of all the events NRL hosted during Q1 of 2018 are highlighted below:

Table-2 –NRL Organized Workshops in MedLab

Date

Event

Topic

Speaker

February 6th 2018

Genetics workshop during MedLab 2018

Hereditary cancers screening

Dr. Clay Gipson, Ph.D
Vice President, Medical Science Liaison
LabCorp/Integrated Oncology (USA)

February 6th 2018

Genetics workshop during MedLab 2018

The Role of Genetic Counseling in the Era of Personalized Genetic Medicine

Rifaat Rawashdeh, MS, CGC
National Reference Laboratory (UAE)
Genetic Counselor

February 6th 2018

Genetics workshop during MedLab 2018

Genetic Testing in a Post Genome World, a User’s Guide

Dr. Marshall Summar
Director, Rare Disease Institute
Children's National Health System (USA)

February 7th 2018

Laboratory Accreditation workshop

Globally Recognized Standards and the Medical Laboratory

Patrick Mateta
Vice President of CLSI Global Health Partnership, USA

February 7th 2018

Laboratory Accreditation workshop

The Role of the National Accreditation System in the UAE Healthcare

Dr. Rehab Al Ameri
Director of Emirates National Accreditation System, UAE

February 7th 2018

Laboratory Accreditation workshop

Pre-analytical Quality Improvement

Dr. Bruce Williams
President of the College of American Pathologists, USA

February 7th 2018

Laboratory Accreditation workshop

Test Method Validation

Faisal Ibrahim, MBA, MT (ASCP)
Director of Quality Assurance, National Reference Laboratory, UAE

February 7th 2018

Laboratory Accreditation workshop

Blood and Urine Contamination Rates

Dr. Elizabeth Wagar
Medical Director, The University of Texas, MD Anderson Cancer Center, USA


2.New Test Integration

Purpose:

Test menu expansion to achieve enhanced patient, quality care and business growth is an area that must be monitored for appropriate management. Patient and client impact and the cost to integrate new tests and sustain the current test menu are key considerations in this endeavor.  NRL collects all relevant data before an assay is added to the test compendium to ensure quality of care and operational processes.

During Q1 2018, the following tests were integrated into NRL’s test menu and are now offered to all clients.

Order Code Name

Methodology

HLA-A Typing Whole Blood

SSO or SSP

HLA B Typing Whole Blood

SSO or SSP

HLA-C Typing Whole Blood

SSO or SSP

HLA DRB1 Typing Whole Blood

SSO or SSP

HLA DQA1/DQB1 Typing Whole Blood

SSO or SSP

HLA DPA1/DPB1 Typing Whole Blood

SSO or SSP

HLA DRB345 Typing Whole Blood

SSO or SSP

HLA Class I Antibody Specificity Serum

LSA

HLA Class II Antibody Specificity Serum

LSA

Allogenic Flow Crossmatch Whole Blood

Flow cytometry

Autologous Flow Crossmatch Whole Blood

Flow cytometry

Donor Specific Antibody Monitoring Test Serum

LSA

HLA Typing Profile Whole Blood

SSO or  SSP

HLA Panel Reactive Antibody Serum

LSM

H-Caldesmon

Immunohistochemistry (IHC)

Glutamine Synthetase

Immunohistochemistry (IHC)

Renal Cell Carcinoma (RCC)

Immunohistochemistry (IHC)

KEY PERFORMANCE INDICATORS

1.Technical Support / Speed of Answering Calls

Purpose:

Technical Support responsiveness is central to other indicators. The timely support provided to clients ensures that the answers to their questions will facilitate more accurate specimen submission and/or process completion.  Therefore, tracking and improving processes relative to call abandon rates is an indicator of customer satisfaction.

The average time it takes to answer a telephone call is measured in ‘wait time’ which is the average time, in seconds, that a caller waits/holds in queue for a Technical Support Representative.

Target: 12 seconds

Average Client wait time -2018

Actions Taken and Outcome

Delay in response of attending calls was identified as a concern during January and Febraury 2018 due to staffing issues.  Scheduling of the technical support staff ROTA has been modified to include additional coverage during the morning shift hours as the majority of calls are received in the early hours.  This enhancement to the schedule has decreased the wait time down to 7 seconds in March 2018.    Technical Support supervisor is contining to monitor this KPI to ensure stability in order to maintain the less than 12 second target.

2.Quality Concerns/Non-Conformities Monitoring

Purpose:

The investigation, review and monitoring of nonconformities is an important component of NRL’s Quality Management System (QMS). Utilizing the Corrective Action Preventive Action (CAPA) module in NRL’s electronic, document control management system, the QA department is able to identify, track and control nonconformities which are referred to as Quality Concerns.

Identifying the root cause of non-conformities is essential for continuous quality improvement.

Monthly Quality Concern Meetings are held with representatives from all departments including management, finance/insurance, business development, technical operations and information technology. The meetings focus on data review and analysis for associated improvement.  Their mission is to:

  • enhance NRL’s level of service provided to clients
  • detect potential errors internally and identify educational opportunities
  • identify the root cause of non-conformities and formulate corrective and preventive action plans
  • monitor quality concern data and key performance indicators

Target: < 0.05% of total monthly test volumes

Overall Rate of Quality Concerns in Q1 2018

3.Specimen Rejection

Purpose:

Specimens arriving in the laboratory must meet the stability and volume requirements for each test requested and each container submitted. Specimens that do not fulfill the documented criteria will be rejected prior to test processing. The rejections are monitored for process improvement opportunities to assist in client education endeavors.

The following are examples of circumstances under which a sample will be rejected:

  • Insufficient Volume
  • Hemolysis
  • Under-Filled or Over-Filled Specimen Tubes
  • Clotted Whole Blood Sample

Target: < 0.3% of total monthly test volumes

4.Turnaround Time (from sample receipt to result reporting)

Purpose:

The timeliness with which laboratories deliver test results is a visible parameter of laboratory service and a common standard by which clinicians and accreditation organizations judge laboratory performance.

Absolute measurements of laboratory test turnaround times (TATs) are an indicator of the process by which services are delivered. Those TATs that exceed the expectations of the clinicians who order the associated tests may be responsible for perceptions of inadequate laboratory service.

Target: >/=95% of total monthly test volumes

Actions Taken and Outcome

In the month of February the threshold was not met. 

Stock-out of allergy and ANA IFA kits contributed to the delay in TAT as these tests were sent out to referral laboratory for testing.Major delays are notified to clients and our supply chain management department is closely working with the vendors to address such stock-out issues.

5.Proficiency Testing Score

Purpose:

Proficiency Testing is an evaluation of a participant’s performance against pre-established criteria by means of inter laboratory comparison. It determines the performance of individual laboratories for specific tests or measurements and is used to monitor laboratories’ continuing performance.

Proficiency testing (PT) is a basic component of laboratory quality-management systems which serves as the main external QC/QA tool. In addition to its regulatory and educational aspects and its value as an efficient tool to monitor overall laboratory performance, PT measures the ability of a laboratory to use a given instrument or to apply a certain method accurately. It provides insight into measurement processes and allows each lab to compare its test results to those of the most appropriate peer group (comprised of other laboratories that use the same or similar instruments and methods).

Target: PT score of > 90%

NRL QUALITY DASHBOARD - Q1 2018