EXTERNAL QUALITY ASSESSMENT
Take the laboratory scientist on the bench who participated in an unusual case presented in a UK NEQAS CPD morphology programme. A few months later, they were working out of hours and encountered a similar case in middle of the night. Their CPD experience gave them the knowledge and confidence to refer the case to medical staff with their opinion of the possible diagnosis, contributing to a more effective commencement of the correct treatment for the patient. This is the value of EQA education in action.
UK NEQAS EQA programmes highlighted the suboptimal – but previously common – practice of inspecting CSF samples by holding them up to the light to determine the presence of bilirubin.
Breadth and depth Delivering the COVID-19 antibody testing in just four weeks was thanks to the expertise – and of course the dedication – of the UK NEQAS team members, who worked long hours to meet the challenge. Every UK NEQAS programme is designed and run by experts and each has demonstrated their commitment to public service. These world-renowned scientists are at the forefront of their chosen speciality and are committed to sharing their knowledge and experiences. Barbara explains more: “The strength of UK NEQAS comes from the breadth of our programmes and the depth of our combined knowledge. The diversity of expertise leads to a creative approach to challenges, particularly when we collaborate. “As Director of UK NEQAS Haematology, I am fortunate to work closely with my colleagues in UK NEQAS Parasitology to offer EQA for the detection and identification of blood parasites to scientists in haematology and microbiology departments. We share cases and collectively review the performance of laboratories for the benefit of all. Our collaboration allows us to provide tailored training to haematology scientists in blood parasite identification. We offer a high frequency of specimens in specialist diagnostic areas, such as the heamoglobinopathies, to ensure that laboratories experience the full range of cases and educational scenarios. Laboratories may be mandated to test
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in this specialty just four times per year, for example, but we consider that this would not allow us to challenge users adequately or to monitor improvements in practice.”
The best EQA provision is a partnership between the laboratory and the EQA provider, working together to improve quality. A common misconception is that we are in place to ‘catch people out’ but our raison d’être is continuous improvement, cemented in the fact that all UK NEQAS programmes are accredited to ISO17043, which requires that we provide education. This comes in many forms including delivering real-life scenarios, a wide range of cases, and a high frequency of specimen distribution, with detailed interpretation of the exercise results in reports. UK NEQAS gives you an opportunity to get things wrong without compromising patient safety. There must be trust on both sides - trust that both parties are focused on the same end goal of improving patient outcomes - so establishing a strong partnership by talking, learning about each other, and sharing a goal is imperative.
Ensuring patient safety A large part of our role is troubleshooting, identifying and sharing the source of common issues. When an issue is discovered by one laboratory, the details are shared with all users through comprehensive and detailed educational reports. These ‘lessons’ are also used to inform best practice guidelines. Consider the previously common practice of inspecting CSF samples by holding them up to the light to determine the presence of bilirubin in a potential patient with subarachnoid haemorrhage (bleed on the brain). This subjective practice was very common in both UK and overseas laboratories. Our EQA programmes highlighted the suboptimal practice, allowing UK NEQAS the opportunity to educate the scientific teams within laboratories, ultimately ensuring more accurate results, improved diagnosis and patient outcomes. This is now embedded in the relevant best practice guidelines in the UK and in many countries globally. UK NEQAS uses EQA performance to monitor the adherence to national and international guidance, for example, the English NHS Antenatal Sickle Cell and Thalassaemia Programme advises testing the baby’s biological father in any pregnancy resulting from egg donation. UK NEQAS Haematology, through the provision of clinical scenarios as part of the haemoglobinopathy screening programme, has demonstrated an improvement in compliance with this guidance over the past five years, and shared this information at programme training days.
Our integral role throughout the end-to-end testing process enables us to capture, analyse and share data-based insights and ultimately, it is this data that informs the shared knowledge of laboratory medicine
AUGUST 2024
WWW.PATHOLOGYINPRACTICE.COM
Arif Biswas /
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