External Quality Assessment in Laboratory Testing

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Questions and Answers

What is the primary purpose of External Quality Assessment (EQA)?

To compare laboratory results with international standards

To inspect laboratory facilities

To challenge participants' quality systems and encourage improvement (correct)

To provide training to laboratory staff

What is another term for External Quality Assessment (EQA)?

Internal Quality Control

Proficiency Testing (PT) (correct)

Laboratory Accreditation

Quality Improvement Program

What is one of the benefits of External Quality Assessment (EQA)?

It reduces the workload of laboratory staff

It provides early warning for systematic problems (correct)

It is only required for small laboratories

It increases the cost of laboratory operations

What is NOT a principle of EQA Schemes?

To provide incentives for poor performance Signup and view all the answers

What is the outcome of effective External Quality Assessment (EQA)?

Physicians, patients, and health authorities are assured of reliable laboratory results Signup and view all the answers

What type of samples are used in External Quality Assessment (EQA)?

Blinded samples that closely simulate clinical material Signup and view all the answers

What happens to the report if all results pass the evaluation?

It is placed in the department EQA file after discussing with AGM LAB. Signup and view all the answers

What is the purpose of the CPA meeting?

To discuss the results with concerned section supervisor/ Manager, AGM LAB and find root cause. Signup and view all the answers

What is a possible source of analytical problems in EQA?

Reagents, instruments, test methods, calibrations and calculations Signup and view all the answers

What can be a source of error in post-examination?

Clerical or transcription errors Signup and view all the answers

What happens if any parameter does not pass the evaluation?

The QA Coordinator initiates CPA. Signup and view all the answers

What is the purpose of a peer group in EQA?

To analyze the same specimens using the same brand and model of instruments. Signup and view all the answers

What can be a problem in pre-examination?

Improper storage of samples Signup and view all the answers

Who attends the CPA meeting?

QA Coordinator, concerned section supervisor/ Manager, AGM LAB Signup and view all the answers

What does the standard deviation measure in a laboratory test?

The repeatability of the test at specific concentrations Signup and view all the answers

Why is good precision important in laboratory tests?

To track treatment or disease progress in a patient Signup and view all the answers

What is the coefficient of variation (CV) in laboratory testing?

The ratio of the standard deviation to the mean Signup and view all the answers

How is bias measured in laboratory testing?

By comparing the results to a target value or estimate Signup and view all the answers

What is the purpose of the mode in laboratory testing?

To evaluate laboratory performance and identify potential deviations or biases Signup and view all the answers

What does the mean represent in laboratory testing?

The average of the results in a laboratory test Signup and view all the answers

What is the formula to calculate bias in laboratory testing?

Bias % = Lab Mean - Concensus Group mean * 100 Signup and view all the answers

Why is it important to have repeated measurements of the same specimen in laboratory testing?

To have results as close to each other as possible Signup and view all the answers

What is the primary purpose of the mode in EQA?

To serve as a reference point for evaluating laboratory performance, setting targets, and monitoring trends Signup and view all the answers

What can be revealed by proper analysis of EQAS testing results?

Potential problems before failure in EQAS or even an adverse patient result Signup and view all the answers

How can problems be recognized in EQAS results?

By comparing results to the target peer group mean Signup and view all the answers

What type of error is indicated by results consistently being different from the target peer group mean?

Systematic error Signup and view all the answers

What type of error is indicated by results showing larger deviations on one side or both sides of the mean?

Random error Signup and view all the answers

Why is it important to review both the present cycle results and performance from previous cycles for the same analyte?

To identify trends and potential problems Signup and view all the answers

What is an important feature of a good EQA scheme?

Internationally recognized with many participating laboratories Signup and view all the answers

What is the benefit of EQA for the patient?

Knows the system is working together to ensure the public receives accurate and useful information Signup and view all the answers

What should be done with EQA samples upon receipt?

Analyze them immediately, if not possible store them appropriately and record the delay Signup and view all the answers

What is the role of the QA Person in EQA sample processing?

Receives the samples and hands them over to the concerned department Signup and view all the answers

What is the purpose of EQA?

To ensure system confidence and public recognition Signup and view all the answers

What should be done with leftover EQA samples?

Keep them till the final report of the sample is received Signup and view all the answers

What should be done with preparation instructions provided with EQA samples?

Adhere to them exactly Signup and view all the answers

What is an important step in the EQA process?

Analyzing EQA samples in good time Signup and view all the answers

Study Notes

External Quality Assessment (EQA)

An external quality monitoring scheme that consists of "blinded" samples that closely simulate clinical material
A technique to challenge a laboratory's internal QC methods and procedures
A program to assess laboratory performance and the ability to determine the "correct" result
Also termed Proficiency Testing (PT)

Importance of EQA

Important for improvement
A measure of laboratory performance

Principles of EQA Schemes

Challenge participants' quality systems
Encourage inter-laboratory comparability
Encourage improvement
Provide insight into national/international levels of performance
Allow poor performance to be addressed
Excellent source of reference material
Required in licensing (accreditation)

Quality Improvement

Provides early warning for systematic problems associated with kits or operations
Provides objective evidence of testing quality
Indicates areas that need improvement
Identifies training needs
Helps to ensure physicians, patients, and health authorities that the laboratory can produce reliable results

Characteristics of a Good EQA Scheme

Internationally recognized
Has many participating laboratories
Numerous and varied samples
Several distributions throughout the year
Rapid report turnaround
Preferably electronic result entry and report return
Friendly and helpful – advice in trouble-shooting
Educational

EQA Process

Management Process
- Choose the right Scheme for your needs
- Analyze EQA samples in good time
- Treat EQA samples same as patient samples
- Monitor and maintain records
- Investigate deficiencies
- Manage corrective action efforts
- Communicate outcomes

Benefits of EQA

The Laboratory
- System confidence
- Self-assessment and recognition
- Public confidence
The Patient
- Knows the system is working together to ensure the public receives accurate and useful information

EQA Sample Processing

Receive and process EQA samples
Analyze data and submit to QA Coordinator
Enter data in respective accounts provided by the EQA body
Keep leftover samples until the final report is received

EQA Performance Problems

Pre-examination
- Sample may have been compromised during preparation, shipping, or after receipt in the laboratory
- Sample may have been processed or labeled improperly in the laboratory
Examination
- EQA challenge materials may exhibit a matrix effect in the examination system used by the participating laboratory
- Analytical problems should be investigated to determine whether error is random or systemic
Post-examination
- Report format can be confusing
- Interpretation of results can be incorrect
- Clerical or transcription errors can be sources of error

Interpretation of EQA Results

Mean: The mean for a group of data points is simply the calculated average
Coefficient of Variation (CV): The ratio of the standard deviation to the mean
Bias: Measures how far your observed value is from a target value
Lab.Bias % = Lab Mean - Consensus Group mean *100 / Consensus Group mean

Mode

Evaluate laboratory performance: By comparing a laboratory's results to the mode, EQA providers can assess their performance and identify potential deviations or biases
Set target values: The mode can serve as a target value for laboratories to strive for, ensuring that their results are consistent with peer group performance
Monitor trends: Tracking changes in the mode over time helps EQA providers detect shifts in laboratory performance or instrument drift
Improve quality: By analyzing the mode and associated data, EQA providers can identify areas for improvement and implement measures to enhance laboratory quality

Why Analysis of EQAS Reports is Important

Proper analysis of EQAS testing results can reveal problems even before failure in EQAS or even an adverse patient result
Recognizing patterns from graphs
Review both the present cycle results as well as performance from previous cycle for the same analyte
Graphs of Z score or SD or RMZ or % deviation for trends

How to Recognize Problems

Results may consistently be different from the target peer group mean - All results on one side of the mean (may be close to mean or at variable distances from mean) Systematic Error
Majority of results are close to the target value but some show larger deviations on one side or both sides of mean – Random Error
Reasons and hence corrective action differs

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Description

This quiz covers the concept of External Quality Assessment (EQA) in laboratory testing, including its importance and methods for evaluating laboratory performance.