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Positive approach in Quality Improvement for Interpretative Commenting in Clinical Chemistry
Quality Assessment of Interpretative Commenting in Clinical Chemistry
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Lynda M Saunders, Medical Scientist /Quality Coordinator
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kjlm{at}bigpond.com Lynda M Saunders
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12th March 2004. Dear Editor, Quality Assurance Programs (1), as mentioned in the article written by Lim et al (2), is a positive approach to setting and enforcing standards through an accreditation process. Certification through an external evaluation of testing enables diagnostic laboratories to be accountable for comments on their results, and effectively to have a review by their peers and experts in clinical chemistry. Interpretative commenting is becoming an important factor in clinical chemistry because of the competitiveness among pathology groups to serve their customers. Due to this supposed positive business impact of giving the customers what they want, this marketing aspect of the pathology business is a moneymaker and, in reality, not essentially a quality priority. The easy-to-read report style with “interpretative comments” assists coctors and specialists looking after their numerous patients. Inappropriate comments can direct clinicians down the wrong pathway, which can cause not only complications to the patient’s welfare but to the healthcare professionals own reputation. Computer software packages, which provide “interpretative comments”, are a common purchase by CEO’s and managers in Pathology Laboratories aiming at a reduction of cost in employing Pathologists and Senior Scientists, but problems arise when key staff with the highest knowledge in clinical chemistry are not the people creating or establishing the data to build the criteria for the appropriate comments. Using Donabedian's framework for examing quality which views quality according to structure, process and outcome (3) is a good foundation for creating a tool to measure the quality of the comments on the reports. Developing clinical indicators and report auditing in one’s own organization, and by external recognized quality assurance bodies, is a good start in improving quality outcomes for the patient. Lim et al (2), point out that quality assurance of interpretative commenting is in its infancy and the various methods of analysis need more work, but this program is a positive improvement to professional development and education, and it is these steps that will ultimately create better patient care and reduce medical adverse events. One needs to remember, “The application and acceptance of Quality Improvement perspective in the healthcare industry requires a fundamental shift in the way we view the world in which we work. It requires what the futurist Joel Barker calls a shift in paradigms”(4). Lynda Saunders Medical Scientist / Quality Coordinator References 1. Royal College of Pathologists Australasia (RCPA Quality Assurance Programs Pty Limited) www.rcpaqap.com.au 2. Lim E, Sikaris K, Gill J, Calleja J, Hickman P, Beilby J, Vasikaran S; Quality Assessment of Interpretative Commenting in Clinical Chemistry. Clin Chem 2004; 50:3:632-637. 3. Donabedian A. The Quality of Care: how can it be assessed? JAMA 1988; 260:1743-1748. 4. Carey RG, Lloyd RC. Measuring Quality Improvement in Healthcare.2001 Chapter 1:p1-12. |
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Adrian C. Sewell, Director, Metabolic Laboratory University Children's Hospital, Frankfurt
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Adrian.Sewell{at}kgu.de Adrian C. Sewell
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Dear Editor: I have read with interest the article by Mun Lim et al. (1) on the topic of interpretative commenting in clinical chemistry. This has a valuable message in that such comments must reflect accepted practice and current guidelines. In their analysis, it was somewhat worrying that a large proportion of the comments were considered inappropriate or misleading. From my own specialist viewpoint, those of us working in the field of inborn errors of metabolism have always provided interpretative comments on our report forms. This is a vital part of the diagnostic service and is justified when dealing with rare diseases. Granted, with most routine laboratory investigations, the sheer volume of results makes the task of commenting insurmountable, let alone the paucity of clinical information provided on request forms! In the course of quality assessment of metabolic investigations for the diagnosis of inborn errors of metabolism within Europe, proficiency testing schemes require comments to be made on the results including recommendations for further investigations and advice for the physician in charge (2). A detailed examination of these comments would give some indication of quality and whether we are on the right track. As a necessary part of gaining laboratory certification (ISO 9001:2000), questionnaires are circulated to referring hospitals and/or physicians in which the point of commenting is specifically addressed. By this means we have been able to improve our commenting procedure. Despite the fact that the practice of attaching comments to laboratory reports is highly varied, drawing up of guidelines would (a) improve our service and, hopefully, at the same time (b) set the stage for [clinicians'] providing (a minimum of) clinical information. You can’t do one without the other! References 1. Mun Lim E, Sikaris KA, Gill J, Calleja J, Hickman PE, Beilby J, Vasikaran SD. Quality assessment of interpretative commenting in clinical chemistry. Clin Chem 2004;50:632—637. 2. Bonham JR. Diagnostic proficiency testing in the UK and Scandanavia (abstract). J. Inherit Metab Dis 2003; 26 Suppl.2:134 |
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