差值检查实践与结果：一项涉及49个医疗机构和6541次差值检查警报的Q-调查研究

Delta Check Practices and Outcomes: A Q-Probes Study Involving 49 Health Care Facilities and 6541 Delta Check Alerts.

作者信息

Schifman Ron B, Talbert Michael, Souers Rhona J

机构信息

From the Diagnostics Department, Southern Arizona VA Healthcare System, Tuscon (Dr Schifman); the Department of Pathology, University of Arizona, Tucson (Dr Schifman); the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (Dr Talbert); and the Surveys Department, College of American Pathologists, Northfield, Illinois (Ms Souers).

出版信息

Arch Pathol Lab Med. 2017 Jun;141(6):813-823. doi: 10.5858/arpa.2016-0161-CP. Epub 2017 Apr 12.

DOI:10.5858/arpa.2016-0161-CP

PMID:28402169

Abstract

CONTEXT

Delta checks serve as a patient-based quality control tool to detect testing problems.

OBJECTIVE

To evaluate delta check practices and outcomes.

DESIGN

Q-Probes participants provided information about delta check policies and procedures. Information about investigations, problems, and corrective actions was prospectively collected for up to 100 testing episodes involving delta check alerts.

RESULTS

Among 4505 testing episodes involving 6541 delta check alerts, the median frequencies of actions taken among 49 laboratories were clinical review, 38.0%; retest, 25.0%, or recheck, 20.2%; current specimen, nothing, 15.4%; analytical check, 5.0%; other; 2%; and retest or check previous specimen, 0%. Rates of any action taken by analyte ranged from 84 of 179 (46.9%) for glucose to 748 of 868 (86.2%) for hemoglobin and potassium. Among 4505 testing episodes, nontesting problems included physiologic causes (1472; 32.7%); treatment causes (1318; 19.2%); and transfusion causes (846; 9.9%). Testing problems included 77 interference (1.7%), 62 contamination (1.4%), 51 clotting (1.1%), 27 other (0.6%), 12 mislabeling (0.3%), and 5 analytical (0.1%). Testing problems by analyte ranged from 13 of 457 (2.8%) for blood urea nitrogen to 12 of 46 (26.1%) for mean corpuscular hemoglobin concentration. Using more delta check analytes was associated with detecting more testing problems (P = .04). More delta check alerts per testing episode resulted in more actions taken (P = .001) and more problems identified (P < .001). The most common outcome among 4500 testing episodes was reporting results without modifications or comments in 2512 (55.8%); results were not reported in 136 (3.0%).

CONCLUSIONS

Actions taken in response to delta check alerts varied widely, and most testing problems detected were preanalytical. Using a higher number of different analytes and evaluating previous specimens may improve delta check practices.

摘要

背景

差异检查作为一种基于患者的质量控制工具，用于检测检测问题。

目的

评估差异检查的实践情况和结果。

设计

Q-Probes参与者提供了有关差异检查政策和程序的信息。前瞻性收集了多达100次涉及差异检查警报的检测事件的调查、问题和纠正措施信息。

结果

在涉及6541次差异检查警报的4505次检测事件中，49个实验室采取行动的中位频率分别为：临床审查，38.0%；重新检测，25.0%，或重新检查，20.2%；当前标本，无操作，15.4%；分析检查，5.0%；其他，2%；重新检测或检查先前标本，0%。每种分析物采取任何行动的比率从葡萄糖的179次中的84次（46.9%）到血红蛋白和钾的868次中的748次（86.2%）不等。在4505次检测事件中，非检测问题包括生理原因（1472例；32.7%）；治疗原因（1318例；19.2%）；以及输血原因（846例；9.9%）。检测问题包括77例干扰（1.7%）、62例污染（1.4%）、51例凝血（1.1%）、27例其他（0.6%）、12例标签错误（0.3%）和5例分析问题（0.1%）。每种分析物的检测问题从血尿素氮的457次中的13次（2.8%）到平均红细胞血红蛋白浓度的46次中的12次（26.1%）不等。使用更多的差异检查分析物与检测到更多的检测问题相关（P = 0.04）。每次检测事件中更多的差异检查警报导致采取更多的行动（P = 0.001）和识别出更多的问题（P < 0.001）。在4500次检测事件中，最常见的结果是在2512次（55.8%）中无修改或注释地报告结果；136次（3.0%）未报告结果。