EXTERNAL QUALITY ASSESSMENT
concerned as it did not understand why the results were incorrect. Thanks to our assistance, the Chair of the relevant Scientific Advisory Group personally contacted the team to deliver guidance and even offered to visit to review the processes in place. This personal touch enabled them to better understand the sensitivity of the test, tweak their internal processes and improve their score. Today, this laboratory is one of the best performing laboratories in this particular UK NEQAS programme.”
UK NEQAS schemes can also offer a personal touch, helping member laboratories to understand their tests, tweak internal processes and improve results.
operated from a dedicated expert centre. These 20 centres are in 11 cities around the UK. Each member centre operates on a strict not-for-profit basis, has no commercial interests, and is accredited to ISO 17043. Together, they deliver over 500 different EQA programmes and a dedicated Pre- and Post- Analytical Quality Monitoring service which has been designed to allow participating laboratories to monitor their pre- and post-analytical issues. When a centre identifies potential issues with a particular test, the UK NEQAS team swings into action to deliver proactive support to enable the laboratory to improve its processes or analysis. Sometimes issues are found with the calibration of testing equipment or the reagents used, other times interpretation may be inappropriate due to training or knowledge gaps. This is where our bespoke constructive guidance makes a real difference. Richard explains: “UK NEQAS is unique in providing education on an individual and collective basis. In my specialism, for example, when a scientist does not fully understand the results delivered by the testing apparatus or does not have the specialist transfusion knowledge to know the effect of results on the selection of blood for transfusion, we are able to contact laboratories directly to discuss the cause of incorrect results and include that information in reports to all laboratories. This is where an open conversation with a member of the UK NEQAS Blood Transfusion team can add real value. In one case, a laboratory performing red-cell genotyping was unaware that one particular blood group is affected
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by a variant, which may be present on the same strand of DNA that stops the blood group being expressed on the red cells. By discussing this in our reports, we closed a knowledge gap and shared the information with other laboratories. This information ensures that the patients have appropriate blood selected should they need a transfusion. “To support this education, the Blood
Transfusion team developed a ‘virtual lab’ that allows an individual to view a sample and complete the relevant testing and documentation. It’s not a competency assessment but it does allow individuals to ensure that their answers are correct as per current UK guidelines. Incorrect answers can be reviewed by managers and additional training provided when required.” It’s this combination of proactive and
transparent support delivered in ways that make tangible differences that builds trust and a solid working relationship between UK NEQAS, participants, and the laboratory teams. It means that laboratories proactively contact UK NEQAS when they become aware of issues and often ahead of them receiving a borderline or unsatisfactory UK NEQAS report. This allows the EQA experts to deliver tailored feedback to participants: subjective guidance that constructively supports the laboratories to deliver improvements. Richard shares another great example
regarding a laboratory offering flow cytometry testing in cases of feto- maternal haemorrhage. “The laboratory completed three EQA exercises, delivering results that meant that it was likely to be labelled ‘unsatisfactory’. Naturally, the laboratory team was
Sharing specialist knowledge UK NEQAS demonstrates a real commitment to participants needing extra support – and our offer is far wider than this. The identifying factors associated with satisfactory or unsatisfactory performance are shared with participants, by regularly publishing in peer-reviewed journals, by hosting scientific meetings, posting videos on YouTube and running educational webinars. Melody expands in relation to genomic testing. “Our aim is to disseminate information as widely as possible. Although robust results can be obtained from genomic testing, there is often variation in their interpretation, within prescribed parameters. This can cause potential issues, so we pull together a panel of volunteer expert advisors so that each report is read and assessed by multiple experts. We see a diverse range of reporting styles and tailor the feedback provided to each individual participant. We have seen centres implement an overall summary statement at the start of each report and produce clearer reports to reduce ambiguity for the clinicians. “We give participants access to our past EQA Summary reports, including new participants, so they can read the previous feedback for themselves and start learning straight away. Our online case scenarios are often used as training resources and completed by multiple staff members within a laboratory. “Subjective interpretation also requires the need for consensus professional guidelines, so the UK NEQAS experts are often part of the groups creating these. Not only do we help create the guidelines we support the enabling of access so that they are freely available to as many people as possible.”
Widening participation Whilst we are naturally specialists in our own field, increasing awareness through widening participation can only help patients no matter where they are in the world. It also broadens perspectives. We are fortunate that we are based in a country with strong research and high
OCTOBER 2024
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