“We are fortunate that our public health care system is highly valued across the board, but each hospital is its own organization,” explains Dr. Paul Yip. “Although the differences appear small, the measures for diagnostic quality may not be the same in every hospital.”
Dr. Yip is Associate Professor in the Department of Laboratory Medicine and Pathobiology (LMP) at the University of Toronto, and Division Head of Clinical Chemistry and Point of Care Testing at Sunnybrook Health Sciences Centre. He is one of the leaders of a task force in LMP’s Quality Council dedicated to Quality Indicators in hospital laboratories. The group has worked with the Toronto area clinical laboratory community to agree on Core Laboratory Quality Indicators (QIs) and are now working towards implementation.
Quality Indicators: data-driven patient safety
Quality underlies all activities in Laboratory Medicine to enable the best possible outcomes for service delivery and patient care. Laboratory standards are used to ensure quality, enable transferability of testing services, and benchmark performance. “But what is quality and is there a universal standard for it? There are many ways to approach this question and the pursuit of better quality never ends,” states Yip.
LMP Department Chair and Chief of Laboratory Medicine at Mount Sinai, Dr. Rita Kandel, established the portfolio resulting in the formation of the LMP Quality Council, led by Dr. Khosrow Adeli, Head of Clinical Biochemistry at SickKids. They brought together a core group of clinical laboratory experts representing the diversity of disciplines and hospitals across the U of T network.
Recognizing that laboratory users and ordering providers encounter different practices, the group quickly sought to leverage the academic collaboration across organizations for better standardization and harmonization. The Council's efforts will contribute to quality and patient safety through several projects, including the harmonization of Quality Indicators.
The Clinical and Laboratory Standards Institute (CLSI) defines a Quality Indicator as “observations, statistics, or data defined by the organization or service that typify the performance of a given work process and provide evidence that the organization or service is meeting its quality intentions.” These indicators are also referred to as “key performance indicator” or “quality metric.”
“Laboratory Medicine plays a central role in patient care in the diagnosis, treatment, and outcomes through testing of the highest quality. ‘The right test, right patient, right time...’ is often said but how do we know this is true? If we do not hold ourselves accountable, the risk of waste, errors, or - worst of all - harm to patients damages the trust that society places in our health care,” says Yip.
Achieving consensus across hospital networks through collaboration
The LMP Quality Indicators project has two main areas: Core Laboratory QIs, led by Dr. Yip, and Anatomic Pathology QIs, led by LMP Associate Professors Dr. Corwyn Rowsell (Unity Health Toronto) and Dr. Zeina Ghorab (Sunnybrook).
Some guidelines have been developed by various bodies, but the taskforces needed to make indicators more relevant and applicable by working directly in collaboration with the Greater Toronto Area clinical laboratory leaders. They devised and circulated surveys to all academic and community hospitals in the Toronto area and received an excellent response rate representing more than 10 hospital organizations. The results were shared with the community during virtual workshops that involved laboratory leaders, administrators, and specialists.
After the first workshop in 2021, the team published a preliminary consensus of 10 Core Lab Quality Indicators in April, which served as a foundation to harmonize laboratory metrics and promote patient safety. While Quality Indicators are not new to Laboratory Medicine, the process to reach a consensus took considerable effort, so the Council aims to publish its findings in a peer review journal.
Two topics that emerged from this consensus were Turnaround Times (TAT – the time taken from a test being ordered to the results arriving back to the ordering clinician) and hemolysis (damage to blood cells which can interfere with test results). Dr. Davor Brinc (University Health Network), and Dr. Saranya Arnoldo (William Osler Health System) had already completed significant process improvements in these areas, so the group opted to focus on these rates at different hospitals to explore where indicators could make a difference.
To discuss this, the group arranged a follow-up workshop in May 2022: Core Lab Quality: Turning Indicators into Action, involving Dr. Lusia Sepiashvili (SickKids), Dr. Davor Brinc, and Dr. Saranya Arnoldo. Almost 100 laboratory specialists and leaders attended from across Canada, working through evidence-based discussions of the impact of turnaround times and hemolysis rates on patient care.
Access to a benchmarking database of Quality Indicators
Unlike Anatomical Pathology QIs where Ontario laboratories report certain data to Cancer Care Ontario, there is no centralized data collection in the province for core laboratory data. This means there is no way for hospital laboratories to benchmark their performance.
The Société Québécoise de Biologie Clinique (SQBC) launched an online platform to submit data for Core Laboratory QIs under a provincial mandate in Quebec. Rather than reinventing the wheel, some laboratories in the Greater Toronto Area have joined voluntarily with several laboratories nationally to submit data to this platform. The Council is therefore encouraging laboratories across Ontario to do the same, after approval from their individual hospitals, providing peer support and advice on preparing their data to submit to the platform.
The Council is now working to improve uptake of the identified 10 Core Lab Quality Indicators within the clinical laboratory community across Toronto.
“This project is a fantastic demonstration of how the clinical laboratory community collaborates and works together to improve quality standards and patient care. I’m pleased how we have been able to play a role in coordinating this effort and I’m looking forward to expanding these efforts across more sites,” stated Yip.
New members or laboratories are always welcome to join the Council. Contact Dr. Khosrow Adeli, Quality Council Chair, at khosrow.adeli@sickkids.ca.
