EQAS: Experience, Challenges and Trouble Shooting as a Participating Laboratory in Public Sector

Introduction: Quality assurance (QA) is an indispensible part of medical laboratory processes for systemic monitoring of operation in clinical laboratory. It consists of internal quality control (IQC) and external quality assessment scheme (EQAS). Quality assurance incudes all the three phases of laboratory system that is pre analytical, analytical and post analytical. It takes into consideration the overall program related to a laboratory and thus ensures that the final report/result released by the laboratory are correct. Quality control is a process through which a laboratory ensures that, it's products quality is maintained or improved and manufacturing errors are reduced or eliminated. Quality control refers to the measures that must be included during each test run to verify that the test is working properly. Quality control emphasis statistical and non-statistical procedures and is able to detect the problem early enough to prevent their consequences. Objective: Data was collected from EQAS samples received from January 2016 to April 2018 at the Clinical Biochemistry Laboratory of Janakpuri Superspeciality Hospital (An autonomous organization under Delhi government), New Delhi, India for the study. The main purpose of EQA, beside monitoring and documenting the analytical quality is to identify poor performance to detect analytical errors, and to take corrective actions for the same. Methods: Four lyophilized samples received on quarterly basis that were stored at required optimum temperature, reconstituted and analyzed as per instruction and guidelines provided by the EQAS organizing body. Every month an unknown/blind sample provided by Christian Medical College, Vellore is reconstituted as per instruction on schedule date, analyzed for the number of parameters for which our laboratory is participating. The results obtained for every particular parameter is uploaded on the official website of CMC, Vellore on or before the schedule date as per the protocol. Our performance score was downloaded after completion of each month. The tests were performed on the fully automated biochemistry analyzer Erba Transasia XL 1000. Results: On analyzing, the monthly VIS of all the selected parameters for the study year 2016 - 2018 the laboratory's performance was found to be very good as (VIS less than 200) in 14.6 % of the total selected parameters for the year 2016 and 8.2 % in all the selected parameters for the year 2017 respectively. The performance in terms of VIS for the year 2018 was found to be equally good as VIS (less than 100) in 95.1 % in all the selected parameters. Conclusion: The overall performance of laboratory as far as OMVIS is considered for the study year 2016, 2017 and 2018 is found to be very good with 90.3% of the value falling below 100 in the year 2017, and 95.1% of the value falling below 100 for the year 2018 (till May). However, the values of calcium, phosphorus, sodium and potassium crossed greater than200 in the month of February, March and July in the year 2017, the possible reason being quality of water supply in the institute.