Quality Improvement Metrics Q2 2018

INTRODUCTION

As the largest College of American Pathologists (CAP) accredited referral laboratory network in the Middle East, NRL continues to focus on the importance of accreditation and the implementation of international medical laboratory standards.  Throughout 2018, NRL Quality Assurance (QA) department has been engaged with accreditation preparation and readiness efforts for all of the sites within the network. 

Table 1 – NRL Inspection Status – Q1 and Q2 2018

NRL Facility

Accreditation Body

Status

Date

Valiant Clinic

JCI

Initial Inspection

January 23, 2018

NRL Anatomic Pathology Laboratory at Cleveland Clinics Abu Dhabi

ISO 15189

Surveillance Inspection

April 24 and 25, 2018

NRL Industrial City of Abu Dhabi (Headquarters)

OSHAD

 Third Party OHS audit

May 8, 2018

Imperial College London Diabetes Center - Abu Dhabi

CAP

Reaccreditation

June 3, 2018 

Imperial College London Diabetes Center - Al Ain

CAP

Reaccreditation

June 4, 2018


Additionally, NRL’s QA and technical teams have diligently worked to achieve General Civil Aviation Authority (GCAA) accreditation.  The GCAA facility certificate was received in June 2018, making NRL one of only four laboratories approved by GCAA to perform drug and alcohol testing for aviation-related companies in the UAE.   GCAA was created in 1996 by the Federal Cabinet Decree to regulate Civil Aviation and provide designated aviation services.  One of GCAA’s objectives is to develop and enforce safety and security regulations according to international standards and best practices.  NRL is proud to be able to provide and contribute to such services of the aviation industry within the region.

Figure 1 – NRL’s GCAA Certificate of Accreditation

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. 

During Q2 2018, NRL participated in a number of national and international conferences including Roche Days, Middle East Laboratory and Diagnostics Congress and the first Gulf Thyroid Forum. These events focused on  the latest advancements in laboratory medicine and international guidelines.

Table 2 – NRL Participation in Q2 2018 Conferences

Date

Event

Topic

NRL Speaker

April 16, 2018

Roche Days

Empowering Improved Medical Decision-Making: The Pivotal Role in Clinical Laboratories within the Healthcare Value Chain

Abdul Hamid Oubeisi, CEO

April 27, 2018

Middle East Laboratory and Diagnostics Congress

The Role of the QA Program in Optimizing Laboratory Cost Management

Faisal Ibrahim, Director of Quality Assurance

April 27, 2018

Middle East Laboratory and Diagnostics Congress

Total Laboratory Automation: The forefront of Increasing Laboratory Quality and Efficiencies for Improved Patient Outcome

Albarah El-Khani, Director of Technical Operations

April 27, 2018

Middle East Laboratory and Diagnostics Congress

Liquid Biopsy and Gynecological Malignancies

Dr. Basel Altrabulsi, Chief Medical Officer

April 27, 2018

Middle East Laboratory and Diagnostics Congress

Recent Advances in Cervical Squamous Epithelial Lesions

Dr. Suhaila Alameeri,  AP Pathologist,

May 11, 2018

1st Gulf Thyroid Forum

First Update on TNM Staging for Thyroid Cancer 

Dr. Basel Altrabulsi, Chief Medical Officer

May 11, 2018

1st Gulf Thyroid Forum

Second NIFTP and Molecular Testing 

Dr. Basel Altrabulsi, Chief Medical Officer


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 Q2 2018, the following tests were integrated into NRL’s test menu and are now offered to all clients:

Order Code

Order Code Name

Specimen Type

Volume

Specimen container

138693

Cytomegalovirus Qualitative, Plasma,  PCR

Plasma

Minimum 500 ul

Lavender (EDTA) tube

138693

Cytomegalovirus Qualitative, Urine, PCR

Urine

Minimum 500 ul

Sterile Container

138693

Cytomegalovirus Qualitative, Ocular Humor, PCR

Ocular Humor

Minimum 500 ul

Sterile Container

138313

Varicella Zoster Virus Qualitative, Ocular Humor, PCR

Ocular Humor

Minimum 500 ul

Sterile Container

138313

Varicella Zoster Virus Qualitative, CSF, PCR

CSF

Minimum 500 ul

Sterile Container

138313

Varicella Zoster Virus Qualitative, UTM swab, PCR

UTM

One swab

UTM Swab

138313

Varicella Zoster Virus Qualitative, EDTA Blood, PCR

EDTA Blood

Minimum 500 ul

Lavender (EDTA) tube

138651

Herpes Simplex Virus 1 & 2 Qualitative, Ocular Humor, PCR

Ocular Humor

Minimum 500 ul

Sterile Container

138651

Herpes Simplex Virus 1 & 2 Qualitative, CSF, PCR

CSF

Minimum 500 ul

Sterile Container

138651

Herpes Simplex Virus 1 & 2 Qualitative, Vaginal swab, PCR

Aptima Vaginal Swab

One swab

Aptima tube

138651

Herpes Simplex Virus 1 & 2 Qualitative, EDTA Blood, PCR

EDTA Blood

Minimum 500 ul

Lavender (EDTA) tube

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 of total monthly answered calls

Outcome:

Technical Support (TS) response time for Q2 2018 met the < 12 second target with an average of 10 seconds.

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

Outcome:

Rate of Quality Concerns for Q2 2018 met the < 0.05% target with an average of 0.012%.

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: < 0.5% of total monthly test volumes

Outcome:

Specimen Rejection Rate for Q2 2018 met the < 0.5% target with an average of 0.14%.

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: > 90% of total monthly test volumes

Outcome:

Turn Around Time (TAT) Rate for Q2 2018 met the > 90% target with an average of  95%.

NRL QUALITY DASHBOARD - Q2 2018