A Survey of Quality Indicator Use in the Clinical Laboratory

Abstract

OBJECTIVE: A survey of clinical laboratories was conducted to capture information about quality indicators in use within the state of Arizona. This information was then used to determine which quality indicators are applicable across the spectrum of clinical laboratories making them suitable for benchmarking laboratory performance. The objectives of this study were also to heighten awareness of benchmarking practices for clinical laboratory managers and laboratory quality assurance personnel, to develop objective methods of quality monitoring for performance improvement, and to encourage collaboration between laboratories and accreditation agencies.

METHODS: A review of the current literature was conducted to assess the status of benchmarking within the clinical laboratory. Data were also obtained from the Centers for Medicare & Medicaid Services (CMS) about all licensed clinical laboratories in Arizona. A mail survey was then created and conducted to investigate the use of clinical laboratory quality indicators in Arizona.

SETTING AND PARTICIPANTS: A paper survey was mailed to a representative sample of clinical laboratory managers included in the CMS licensed laboratories listing for the state of Arizona.

MAIN OUTCOME MEASURES: The selected sample was surveyed by mail and validation testing of the survey was conducted using the t-test. The compiled survey data is also presented in the form of histograms.

RESULTS: Applying the t-test to the sample vs. population data proved that the sample was not a very good representation of the population and a better selection method should be used in future studies. Of the 319 of 3198 clinical laboratories randomly selected to receive the survey, 21 (6.58% of the sample or 0.66% of the population) responded with completed surveys. The information received from the respondents revealed a relationship between test volume and the number of indicators being monitored by clinical laboratories, the preference of indicators being monitored by those laboratories, the size of the laboratories where the majority of benchmarking is occurring, and a link between accrediting agencies and benchmarking activities.

CONCLUSION: The survey proved that quality indicators are used for quality improvement purposes within the clinical laboratory; although it also showed that the industry still does not have a standardized approach to the use of quality indicators for benchmarking performance against other laboratories.

ABBREVIATIONS: CAP = College of American Pathologists; CDC = US Centers for Disease Control and Prevention; CLIA = Clinical Laboratory Improvement Act of 1988; CMS = Centers for Medicare & Medicaid Services; JCAHO = Joint Commission on Accreditation of Healthcare Organizations; NQF = National Quality Forum; PPM = provider performed microscopy; TAT = turnaround time.