Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Department of Clinical Chemistry, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Clin Chem Lab Med. 2022 Sep 2;60(11):1719-1728. doi: 10.1515/cclm-2022-0655. Print 2022 Oct 26.
Moving average quality control (MA QC) is a patient-based real-time quality control system. Advantages compared to conventional periodic internal quality control (IQC) include absence of commutability problems and continuous monitoring of performance. We implemented MA QC for multiple routine hematology and chemistry parameters. We describe the evaluation process and provide practical tools to aid MA QC implementation.
Nine parameters (serum sodium, calcium, bicarbonate and free thyroxine, hemoglobin [Hb], mean corpuscular volume, mean corpuscular hemoglobin concentration [MCHC], reticulocyte count and erythrocyte sedimentation rate [ESR]) were chosen for initial consideration. Using data extractions from the laboratory information system (LIS; General Laboratory Information Management System), evaluation of usefulness and optimization of MA QC settings was performed using bias detection curves. After this, MA QC settings were incorporated in our LIS for further evaluation and implementation in routine care.
Three out of nine parameters (Hb, ESR, and sodium) were excluded from MA QC implementation due to high variation and technical issues in the LIS. For the six remaining parameters, MA QC showed added value to IQC and was therefore implemented in the LIS. For three parameters a direct MA alarm work-up method was set up, including newly developed built-in features in the LIS. For the other parameters, we identified MA utilization beyond real-time monitoring.
Implementation of MA QC has added value for our laboratory setting. Additional utilization beyond real-time QC monitoring was identified. We find MA QC especially useful for trend monitoring, detection of small shifts after maintenance and inter-analyzer comparisons.
移动平均质量控制（MA QC）是一种基于患者的实时质量控制系统。与传统的定期内部质量控制（IQC）相比，它具有无可比性问题和连续监测性能的优势。我们为多个常规血液学和化学参数实施了 MA QC。我们描述了评估过程，并提供了实用的工具来帮助实施 MA QC。
选择了九个参数（血清钠、钙、碳酸氢盐和游离甲状腺素、血红蛋白[Hb]、平均红细胞体积、平均红细胞血红蛋白浓度[MCHC]、网织红细胞计数和红细胞沉降率[ESR]）进行初步考虑。使用实验室信息系统（LIS；通用实验室信息管理系统）中的数据提取，使用偏差检测曲线对有用性进行评估和 MA QC 设置的优化。在此之后，将 MA QC 设置合并到我们的 LIS 中，以便在常规护理中进一步评估和实施。
由于 LIS 中的高变异性和技术问题，九个参数中的三个（Hb、ESR 和钠）被排除在 MA QC 实施之外。对于其余的六个参数，MA QC 对 IQC 具有附加价值，因此在 LIS 中实施。对于三个参数，建立了直接的 MA 报警工作流程，包括 LIS 中内置的新开发功能。对于其他参数，我们确定了 MA 的利用超出了实时监测。
在我们的实验室设置中，实施 MA QC 具有附加价值。除了实时 QC 监测之外，还确定了其他利用 MA QC 的方法。我们发现 MA QC 特别适用于趋势监测、维护后小偏移的检测以及不同分析仪之间的比较。
