As one of its starting points, the Institute for Quality in Laboratory Medicine (IQLM) commissioned a survey conducted by the Clinical Laboratory Management Association (CLMA; Wayne, Pennsylvania), and surveys were sent to CLMA members in November 2004.

The survey was an effort to find out "what is really happening in America's hospitals in terms of quality management," Michael Noble, MD, co-chair of the IQLM Networks Workgroup and chair of clinical microbiology proficiency testing at the department of pathology and laboratory medicine at the University of British Columbia (Vancouver, British Columbia), told attendees in Atlanta at the IQLM's first conference.

The survey found that more than 70% of laboratories are conducting physician, patient and employee satisfaction surveys and reviewing incident reports, yet less than 60% of those laboratories have guidelines that dictate when an intervention is need to correct identified quality problems, the IQLM said.

Of the 2,301 U.S. hospital-based laboratories surveyed through CLMA, 572 or 25% responded to a series of questions on laboratory practices and quality initiatives.

"The demonstration survey found that 83% of laboratories responding indicate that they would be interested in participating in a network to learn the best policies and benchmarking opportunities to improve safety and quality in laboratory medicine," said Barbara Goldsmith, PhD, co-chair of the IQLM Networks WorkGroup. "It's an encouraging discovery that highlights the collective desire for improved quality systems."

Noble also said that "a number of interesting trends were identified in the survey. For example, we found that only a small number of laboratories, certainly less than 10%, monitor how clinicians test results or if patients understand the test results they receive from a laboratory. This is important post-analytic information that directly impacts patient care, yet few follow it."

The survey results also emphasized the importance of a variety of healthcare professionals in providing laboratory tests and services.

"When an adverse event occurs, 90% of the laboratories indicated that they interview nurses during follow-up investigations," said Julie Gayken, member of the IQLM Networks Workgroup and director of laboratory services at Regions Hospital (St. Paul, Minnesota).

Among other things, the survey looked at structured review of incident reports and structured review of adverse events that resulted in actual harm to the patient. The survey also looked at which lab events lead to full investigations.

The most common effort at determining negative events was root cause analysis, which was used in 92% of cases, Gayken said.

Karen Young