External quality assessment schemes for clinical laboratories

Abstract

 The clinical routine laboratory generally utilizes cheap, easy and rapid measurement procedures ("methods") in order to meet the requirement for the production of many analytical results (500–3000 per day) of hundreds of different types. The measurement procedures are optimized for the analysis of native patients' samples, but are frequently sensitive to deviation of the composition of the matrix from that in normal fresh samples. The inherent lack of stability of patient samples means that control samples need to be stabilized. The method of stabilization is critical. Furthermore, the method of "spiking" samples with pathological material is a matter of concern. Generally, minimally processed patients' samples should be used in external quality assessment (EQA) schemes. Consensus values are currently the most popular for use as a guide to the best results from participating laboratories in EQA schemes; these often work fairly well. However, the uncertainty and traceability of this type of value is unknown, and in some cases may even be misleading, tending to preserve bad routine methods when these are dominant in the participating laboratories. Reference measurement procedure (RMP) values are recommended to provide scientifically based information, to facilitate the proper choice of methods in the routine laboratories, and to validate the suitability of control materials in EQA schemes. The present paper provides selected examples from a study comparing consensus values with RMP values on lyophilized sera, and also presents results on a fresh frozen thawed serum for the study of commutability.