Use of averages of patient data for quality control

Abstract

 Applicability of Hoffman's average of normals (AON) method was evaluated in quality control (QC) for twenty clinical chemistry assays (ALT, Alb, ALP, AMY, AST, T. Bil, inP, Glu, Ca, Cl, T. Chol, Creat, CK, K, LD, T. Prot., Na, TG, BUN, Uric. A.) performed routinely in the Hospital of Medical Faculty of 9 Eylül University. Consecutive Texas Instruments XL-Dacos patient data were accumulated over 10 days. According to the guidelines developed by Cembrowsky et. al. for the implementation of average of patients (AOP) (also known as AON) procedure, the patient population mean, *_p, population standard deviation, S_p, the ratio of S_p/S_a (S_a, the analytical standard deviation), and the approximate number of patient results averaged. Np (with P_ed=0.50) were determined from the nomogram constructed by Cembrowsky et. al., illustrating the relationship between Np, S_p/S_a, and the probability of detecting a 2S_a shift (P_ed) when the probability of false rejection, P_fr, is 0.01. The control limits and the truncation limits were selected as *_p±2Sp and *_p±2.58×Sp√Np, respectively. The estimated values were assessed for the applicability of AOP procedures in the clinical laboratory. We conclude that the AOP procedure is a valuable tool for instrument monitoring as an adjunct to more costly standard QC procedures and is also an efficient, cost-effective and rapid way of collecting appropriate information on large number of patients.