The Road to Perfect EQA?

WARNING:  As I write this entry, I am wearing my Proficiency Testing hat.  Folks interested in laboratory quality, but not in proficiency testing may find this really boring.  If PT/EQA is NOT your thing, that is OK; please leave NOW.  

The annual meeting for the European Organization for External Quality Assessment for Laboratory Medicine (EQALM) was an excellent get together for EQA providers.   Gradually EQALM is becoming not only the gathering point for European international EQA providers, but intercontinental as well.  

LABQUALITY [http://www.labquality.fi/eqa-eqas/?x2520204=3249645 ] has already written a nice summary on the meeting.  

The theme of this year’s meeting symposium was The Road to Perfect EQA.  That is a pretty good way to celebrate 20 years as a EQA provider group.  The presenters tackled 4 topics (a) Commutability (b) Traceability and (c) Accuracy and (d) the challenge to Homogeneity when internal reagents cause mischief.  All were interesting and important EQA topics, especially if you are focused on producing challenges for Chemistry laboratories.  (Note: that does not include me).  

If I had an issue about what was presented, it was small but important (at least in my mind).  The term commutable is not a particularly good word for EQA because it has a number of meanings.  It can mean “capable of used for commuting” or can mean “capable of being exchanged” or lastly “capable of being converted”.  In the context of EQA, I am pretty sure he was not think about commutability in the context of transportation.  I think the presenter was intending that EQA samples should be sufficiently similar to clinical samples, that they can be used as an exchangeable material in the sense that there are no matrix effects.  EQA samples should act like regular samples.  I can live with that, but in chemistry the term can also mean being converted or degraded to end-products, so you might say you want the sample to be commutable, but you don’t want it to be commutable.  I think the term is probably not the best choice.  

In our clinical microbiology program we try to take the sense of being exchangeable with clinical samples a little further.  We make the sample to contain both host and microbial components, combine pathogenic flora with background flora, and we try to the extent possible to make our samples look like and act like clinical samples; the point being that being exchangeable just for the machine and not for the laboratory workers does not go far enough.

But I have a much bigger issue with what I see as a major weakness in the symposium.  It is about what was not presented.  It was far too technical focused and did not include that the REAL Road to Perfect EQA program is the one that leads laboratories to want to use and learn from EQA.  

In my now near 35 years of PT/EQA with observations around the world in developed and developing countries, I have seen almost every variation to EQA experience.  Most laboratories still see PT/EQA only as something that Accreditation requires, or something they just have to do.  They either never investigate errors, or given the opportunity never even look at results.  When they have a problem they get picky beyond picky on interpretation of instructions or provided clinical information rather than acknowledge that they did not process the sample as required and expected.  And sometimes (fortunately not very often these days) some laboratories use deceptive methods to cheat an answer rather than risk the challenge.

We even have members from our own committee who feel compelled to argue against the challenge when they participated in every part of the selection and preparation process.  We have seen laboratories threaten regulatory action because they felt the challenge was too hard/ too easy/ too costly/ too too…

The Perfect PT/EQA program wouldn’t have any of those responses.  Instead there would be a deluge of letters “Thank you for helping us find our system error” or “Many thanks for that interesting challenge.  We have incorporated a number of changes to take that into consideration”, and especially “Many thanks for those educational and informative critiques.  We can’t get along without them”.

OK, maybe I’m a little over the top, but EQA is an important exercise for all laboratories in all fields; water, food, medical, construction, electrical.  In some areas, detecting errors actually saves lives.  

Having laboratories miss the point of the exercise does no one a service, certainly not to laboratory who chooses to ignore or deflect opportunities to improve, and most certainly not the customer who in our case represents patients, clinicians and the community.  It is a program of purpose.

So, let me propose to my PT/EQA and in particular EQALM colleagues, “good-on-ya’” for a symposium well done and focusing interest on an important side of what we do.  But maybe at the next major anniversary (the 25^th, or 40^th, hopefully we don’t have to wait for the 50^th!) we can have The Road to Perfect EQA – Part B where education and customer focus also get discussed.

SAVE THE DATE:  
October 1-3, 2017
POLQM Fall Conference  on Medical Laboratory Quality