EXTERNAL QUALITY ASSESSMENT
clinical testing for troponin I or T was at 0 hours and 12 hours with monitoring ongoing as determined by the medical team. With the current shortages of hospital beds and the strain on A&E services, it is advantageous to be able to determine much more quickly whether someone is having a heart attack, but ensuring it is still safe to discharge patients earlier. With the development of more sensitive troponin methods, the team in Glasgow monitor with specific samples that these methods are performing accurately at low levels. This has enabled clinical teams to introduce much shorter testing regimes of 0 and 1 hours or 0 and 3 hours for example. Clinicians are able to deliver accurate diagnoses in a timelier manner, which ultimately means faster treatment and the likelihood of a more positive outcome for patients.
With many of its EQA schemes run by individuals who also lead clinical laboratories, UK NEQAS has the ability to reinforce the understanding that the clinical samples belong to real people.
the risk of an incorrect cause of death, which may have legal implications for the healthcare sector, the family, and individuals involved.
Because many of our EQA schemes
are run by individuals who also lead clinical laboratories, UK NEQAS has the ability to reinforce the understanding that the clinical samples belong to real people. Deborah, for example, is part of a multidisciplinary team (MDT) working throughout the end-to-end transplant process and the regular biomarker testing in relation to transplants are obviously attached to specific patients. As Deborah explains: “Over this long period of time, we feel like we get to know our patients – we have no idea what they look like, but we know their results probably better than they do and we genuinely care that they continue to make a good recovery.”
Determining optimum testing regimes
Being a fully independent, not-for-profit organisation enables UK NEQAS to deliver more than EQA. With access to clinical teams and patient outcomes, we are in a unique position to gather data and take a holistic view of testing. This enables us to determine, for example, the optimum testing levels needed to generate the right information for clinicians, so that they can deliver the best diagnosis.
Gwen explains what this means in
relation to her work. “As a biochemist working with centres all over the UK, I’m interested in how EQA can be deployed to deliver both a clinical and an analytical benefit to healthcare. This not only enhances clinical diagnosis, ultimately
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benefiting the patient, it can help the NHS to deliver a cost-effective service.” Another great example is in relation
to creatinine. Creatinine is the waste product of muscle turnover that is removed by kidney filtration and raised levels are a marker for renal failure. By identifying changes in creatinine levels at an early stage, laboratories can flag to clinical teams when patients are at risk of developing acute kidney injury and enable early treatment protocols to be implemented to support kidney function – potentially preventing the patient from needing extensive treatment or ending up in ITU. Obviously, this is beneficial for the patient but it also reduces the cost implications for the NHS. The EQA work done by the UK NEQAS team in Birmingham is essential to ensure that laboratories are correctly identifying accurate creatinine levels. The same is true regarding the testing for troponin I or T and NT-proB- type naturietic peptide (BNP) markers that indicate the risk of acute coronary syndromes and heart failure respectively. The data from the UK NEQAS team in Glasgow has helped to determine new testing regimes to improve clinical support and patient outcomes. Originally
These changes to methodology are possible due to working closely with clinicians and having access to patient outcomes.
Peace of mind
Ensuring that the testing is correct is important from a clinical point of view but how often do we consider the adverse impact of receiving an out-of-the-ordinary result on the patient?
Deborah explains: “When I describe what I do, I share that I am mitigating differences between laboratory testing to ensure that patients receive standardised results no matter which laboratory completes the test. I use the following story about a family member to illustrate what I mean.
“A family member takes the oral anticoagulant, warfarin, so they need regular blood tests to ensure they are taking the correct dosage. They’re used to their INR (international normalised ratio) being at a certain level. One time, this person was on an extended holiday in another part of the UK, and their test was done in a different laboratory to normal. The test came back at a different level and despite being within the reference range, caused unnecessary worry, an immediate end to the holiday, and a request for a second test when they arrived home. Of course, this had a cost
If EQA results are incorrect we work with laboratories providing education and advice to ensure they determine where errors occurred to prevent similar errors in patient samples that could put patient health at risk
SEPTEMBER 2024
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