الفهرس 
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Abstract
Introduction :. Clinical laboratories are of most importance in the health care system and the results of analytical testing have a strong impact in diagnosis and management of diseases. Quality indicators (QIs) are a part of the quality management system (QMS). They are tools to monitor and control efficiency of the laboratory. The aim of this study is to evaluate the total testing process in Mansoura Children’s Hospital (MCH) laboratories using different quality indicators. The aim of the work: To evaluate the total testing process in Mansoura Children’s Hospital laboratories using different quality indicators. The specific objectives are to: To calculate preanalytical QIs and compare between paper and electronic records in Mansoura Children Hospital during the study period and to calculate analytical and postanalytical QIS. Materials and methods: Preanalytical and post analytical phases: evaluation included all routine chemistry and hematology samples which comprise for 74741 samples with exclusion of samples that were not routinely done in chemistry and hematology departments and samples from other laboratory units (microbiology, immunology, and blood bank). In these phases different quality indicators as rejected samples, turnaround time and critical result reporting were calculated in addition to calculation of six sigma. Analytical phase: evaluation of this phase was done by calculation of six sigma for 14 analytes using total error allowable of CLIA 1988 and 2024. In addition to the use of normalized decision chart and quality goal index. Results & Conclusion: The study revealed that preanalytical phase had an overall acceptable performance. Samples not scanned by barcode were 5%. The highest cause of sample rejection was clotting (85.3% of rejection causes). As for the postanalytical phase, 82.9% of samples fell within predefined TAT. Critical result reporting using a convenient sample size showed a poor performance with only 30% reported electrolyte morning critical result. Corrected results showed excellent performance. Six Sigma using CLIA 2024 revealed that triglyceride and GGT for both levels, HDL-C for level 1, ALT and AST for level 2 showed world class performance. However, creatinine and BUN for both levels and glucose for level one showed Sigma less than 3 suggesting poor performance of BUN due to imprecision, creatinine due to inaccuracy and imprecision, and glucose due to imprecision. Recommendations: •It is essential for phlebotomists to receive training. •Autoverification of ABG results to reduce TAT. •Sigma metric calculation should be repeated quarterly or every six months. •An integrated TEa should be chosen as a suitable limit for our laboratory for six Sigma calculation.