Hello
We are reviewing how we maintain agreement with main analysers across sites
in the Trust and the recent string, reproduced below in part, came to mind.
Can I ask your advice, if your labs do this, about what procedures you use.
For example, do you compare patient samples or just compare QCs, and how
often, do you rely on comparison of QC results electronically, assuming the
same batch gives the same results, or regularly send an aliquot around the
sites, and so on? What 'pass' criteria do you use for result agreement?
Are there any guidelines on this?
Regards
Steve
Ps will summarise if enough replies
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-----Original Message-----
From: David Robertshaw [mailto:[log in to unmask]]
Sent: 05 August 2008 15:50
To: [log in to unmask]
Subject: Re: Cross site EQA
Chris - Does IQC actually "control" anything. It gives you a day to day
asssment of the quality of an assay which allows Laboratory staff to do
something to control the quality.
David
>>> Royle Chris <[log in to unmask]> 04/08/08 17:35:20 >>>
Sorry, have I missed something?. IQA. What's that? I thought that EQA
(external quality assessment) and IQC (internal quality control, with the
accent on the word control) were the only terms in use? (nod towards J.
Middle)
Apologies if I'm not keeping up. Seems to be happening more and more these
days.... :-(
Chris
Chris Royle
Service Manager,
Clinical Biochemistry and Haematology Departments,
Royal Brompton and Harefield NHS Trust,
Royal Brompton Hospital,
Sydney Street,
LONDON
SW3 6NP
phone: + 44 (0)20 7351 8413
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-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Hallworth Mike (RLZ)
Sent: 04 August 2008 17:11
To: [log in to unmask]
Subject: Re: Cross site EQA
Hi Janice
I think you've missed David's point. The difference is that lab analysers
have frequent and rigorous IQA checks which POCT analysers generally don't.
These are used to ensure that the right results are going out - and to do it
BEFORE they go out, which is rather better than waiting for the EQA to come
back, when it is a bit late...
In this situation, EQA is telling you primarily about differences in
method/analyser bias rather than poor consumables, instrument malfunctions
etc. And there is a good argument for registering only one analyser for that
purpose, and using the IQA to monitor differences between analysers (I'm not
getting into the 'fiddle factor' debate!!).
I think David raises a legitimate point which merits serious discussion, not
dismissed as you have done.
Mike
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Janice Still
Sent: 04 August 2008 16:55
To: [log in to unmask]
Subject: Re: Cross site EQA
David, I can only assume that you have your tongue firmly in your cheek. If
not, then you have successfully taken my breath away! The analysers may be
the same, the cartridges and reagents may be the same,but what the USERS do
to them is certainly not the same.I am also concerned by your mention of
"tweaking". I thought that we had all abandoned fiddle factors long ago.
Every single one of my analysers is individually EQA enrolled and I would
not have it any other way. Recently the EQA showed a sudden negative bias on
PCO2 on one analyser, which was eventually traced to the sample path not
being kept at 37C. If I was only looking at EQA on one analyser, how would
this have been picked up? If you decided to take the lab as your "typical "
instrument, where it is looked after by qualified BMS staff, what hope
mwould there be for the instrument in A/E and all the misuse that it
gets?You simply CANNOT blithely assume that one size fits all. How do you
know that consumables have been stored correctly, or have been used before
the sell by date? At the end of the day the whole object of EQA is to ensure
that the PATIENT gets the right result on the instrument that their blood is
analysed on. Yes it is expensive. Live with it. And I hope your patients do.
JanMrs. J. Still,
POCT Manager,
Biochemistry Dept,
Watford General Hospital. 01923-217998.
The views expressed in this message are personal and do not reflect West
Herts NHS Hospitals Trust policy.
----- Original Message ----
From: David Robertshaw <[log in to unmask]>
To: [log in to unmask]
Sent: Monday, 4 August, 2008 2:09:19 PM
Subject: Cross site EQA
The Leeds/Bradford Biochemistry service has four sites all with the same
analytical equipment using the same reagents and IQA. IQA performence is
compared regularly and used to "tweak" the analysers to get the same answers
across all sites. Why then do we need to enrol all four sites in the same
EQA scheme?? If one analyser is performing satisfactorily compared to the
"National norm", (as evidenced by EQA), and the other analysers compare
satisfactorily with that one why repeat the EQA analysis?? I believe many
hospitals with several Blood Gas Analysers of the same make will only EQA
one and accept performnce of the others on the basis of IQA. Could this
principle not be applied far more widely particularly in the light of
networking and the fact that equipment, reagent production, cartridge
manufacture and standards are common across many sites.
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