Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?
Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?
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DOI：
10.4102/ajlm.v3i2.222
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发表时间：
2014-01-01
影响因子：
1.1
通讯作者：
Luman, Elizabeth T.
中科院分区：
文献类型：
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作者：
Maina, Robert N.;Mengo, Doris M.;Luman, Elizabeth T.
背景：肯尼亚实施了加强实验室认证管理 (SLMTA) 计划，以促进医学实验室的质量改进并支持国家认证目标。 SLMTA 完成后需要持续的质量改进，以确保可持续性并继续取得认证进展。方法：由合格的独立审核员进行审核，使用逐步实验室质量改进流程认证 (SLIPTA) 检查表来评估五个注册实验室的绩效。对项目结束（退出）和项目后一年（监督）审核的总体评分、星级（根据分数从 0 到 5）以及构成 SLIPTA 检查清单的 12 个质量体系基本 (QSE) 领域的每个领域的分数进行了比较。结果：所有实验室从退出审核到监督审核都有所改进（中值改进 38 个百分点，范围 5-45 个百分点）。两个实验室从零星提高到一星，两个实验室从零星提高到三星，一个实验室从三星提高到四星。退出时 QSE 得分中位数最低的是：内部审计；纠正措施；事件管理和流程改进（< 20%）。 12 个 QSE 中的每一个在监督审核方面都有显着改善，其中客户管理和客户服务、内部审核和信息管理方面的改善最大（= 50 个百分点）。整体改进最大的两个实验室主要侧重于内部审核和纠正措施 QSE。结论：虽然所有实验室都从退出审核到监督审核都有所改进，但那些侧重于内部审核和纠正措施 QSE 的实验室比不重视内部审核和纠正措施 QSE 的实验室进步显着更多；内部审计和纠正措施可能起到催化剂的作用，导致其他 QSE 的改进。系统地确定核心领域和解决这些问题的最佳实践是加强公共医学实验室的关键一步。
Background: Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation.Methods: Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist.Results: All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5-45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (= 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs.Conclusion: Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories.