Proficiency testing in analytical chemistry, microbiology, and laboratory medicine – working group discussions on current status, problems, and future directions

Working group (WG) discussions on proficiency testing (PT) held at the joint Eurachem/ EQALM workshop, Borås, Sweden, 24–26 September 2000 are summarized. The discussions focused on aspects of PT and accreditation (WG 1), general aspects of PT in analytical chemistry (WG 2), microbiology (WG 3), and laboratory medicine (WG 4), incorporation of measurement uncertainty into PT schemes (WG 5), international harmonization of PT schemes (WG 6), and the role of PT in the international structure of chemical measurement (WG 7). Current status, problems and future directions are identified. Each WG contained a majority of participants experienced in the subject being covered by that WG, and a few participants with different expertise. This was done to promote cross-fertilization of ideas between sectors, a key objective of the workshop. The WG issues reflected the content of the keynote lectures and some issues were covered from different perspectives by more than one group.     

Quality assurance in clinical chemistry laboratories in the UK

 Since the mid-1960s quality assurance in clinical chemistry has progressed from a need to define and improve precision and accuracy in analytical test procedures to an all-embracing process of assuring that the whole process of pre-analytical, analytical and post-analytical phases of handling patient samples is managed effectively and efficiently. Automated and computer-controlled equipment has reduced many of the analytical errors, in particular in imprecision, that were present in manual analysis. New management techniques have been developed to control the quality and appropriateness of results. Developments in internal quality control and external quality assessment procedures have enabled laboratories to continually improve the quality of assays. Laboratory accreditation and external quality assessment scheme accreditation have ensured that peer review and peer pressure have been applied to both laboratory and external quality assessment scheme performance. As the NHS reviews its priorities and places more emphasis on primary care provider demands, hospital laboratories will of necessity assist with near patient testing outside the laboratory. This will provide new challenges to the quality of the service provided. Received: 2 July 1998 · Accepted: 1 August 1998     

The correlation of laboratory performance in proficiency testing with other QA characteristics

Although it seems self-evident that proficiency testing (PT) and accreditation can be expected to improve quality, their relative benefits remain uncertain as does their efficacy. The study reported here examines the following issues: (a) Why do laboratories take part in PT schemes? (b) How does participation in PT fit in with a laboratory's overall quality assurance (QA) system? (c) Is there a link between a laboratory's performance in specific PT and it's QA system? (d) How does PT performance change with time and how do laboratories respond to poor performance? The overall conclusion is that there is no evidence from the present study that laboratories with third-party assessment (accreditation and certification) perform any better in PT than laboratories without. The validity of this conclusion and its significance for the future design and operation of such schemes requires further investigation. In particular, study is required of the degree to which good performance in open PT correlates with blind PT performance, where laboratories are not aware that the samples being analysed are part of a quality assessment exercise.     

Quality assurance in the view of a commercial analytical laboratory

 The necessity for analytical quality assurance is primarily a feature of the analytical process itself. With the full establishment of the EU domestic market, it is also becoming a legal necessity for an increasing number of analytical laboratories. The requirements which laboratories will need to fulfil are stipulated in DIN EN 45 001. Accredited testing laboratories must in fact provide evidence that they work solely in accordance with this standard. National and EU commissions, which are legislative authorities, tend therefore to specify analytical methods, e.g. in the form of regulations or appendices thereto, intended to ensure that results from different laboratories will be comparable and hence will stand up in a court of law. The analytical quality assurance system (AQS), introduced by the Baden-Württemberg Ministry for the Environment in 1984, obliges laboratories to regularly participate in collaborative studies and thereby demonstrate their ability to provide suitably accurate analyses. This alone, however, does not sufficiently demonstrate the competence of a laboratory. Only personal appraisal of the laboratory by an auditor, together with the successful analysis of a sample provided by the same and performed under his observation, can provide proof of the competence of the laboratory. From an analytical point of view, the competence of a laboratory must be regarded as the decisive factor. Competence can only be attained through analytical quality assurance, which thus must be demanded of all laboratories. Received: 4 October 1996 Accepted: 15 January 1997     

Proficiency testing in analytical chemistry, microbiology and laboratory medicine: working group discussions on current practice and future directions

A summary of the working group (WG) discussions on proficiency testing (PT) and external quality assessment (EQA) held at the joint EURACHEM/CITAC/EQALM workshop, Bracknell, UK, 16–18 February 2003 is provided. The nine WGs covered a range of issues concerned with current practice and future directions; PT/EQA as a tool for regulators (WG1); PT/EQA as a tool for accreditation (WG2); evaluation of performance and uncertainty (WG3); frequency of PT/EQA participation (WG4); selection of appropriate PT/EQA schemes (WG5); added value of PT/EQA and cost benefit evaluation (WG6); global harmonisation and rationalisation (WG7); new technical areas and challenges in PT/EQA (WG8); and accreditation of PT/EQA providers (WG9). Participants with different backgrounds were on each WG in order to capture a range of views and experience from different sectors. The discussions reflected on the keynote lectures and built, in many cases, on discussions at previous workshops in 2000 and 2002.     

Environmental analysis in the Czech Republic: organisation of proficiency testing and its use in laboratory assessment

The history, origin, and development of a system for monitoring and assessing water and other environmental laboratories in the Czech Republic is described. The system started in 1991 and has matured to its present complexity with similarities to the accreditation systems found in other countries. Differences from internationally recognized procedures are being corrected step by step. During the first year of its existence ASLAB, as part of its brief, organised proficiency testing (PT) programs for fifty laboratories. Today the total number of regularly participating laboratories exceeds 700 from the Czech Republic, the Slovak Republic, and Germany. This paper describes the ASLAB PT system, discusses some experiences with its use, and describes the use of PT results in assessment of the competence of laboratories. Received: 12 October 2000 Accepted: 7 January 2001     

Information system and qualifying criteria for proficiency testing schemes

Since October 1998 the European Commission has financed a concerted action on Information System and Qualifying Criteria for Proficiency Testing Schemes within the 4th framework program. As a major result of this project EPTIS, the European Information System on Proficiency Testing Schemes which is available on the Internet since March 2000, is presented in this paper. Today EPTIS contains comprehensive information on approximately 640 proficiency testing schemes from 16 European countries providing information on the state of the art in proficiency testing in Europe. Finally some possible approaches for interlinkages and recognition of proficiency testing schemes are discussed.     

Accreditation for United States environmental laboratories

 There is currently no national program for recognition of United States environmental laboratories. This situation should change sometime in 1998 as environmental testing laboratories should be able to apply for accreditation in the United States via a system developed by the National Environmental Laboratory Accreditation Conference (NELAC). NELAC is an organization whose purpose is to establish performance standards for accrediting environmental laboratories. Laboratories to be accredited will be required to demonstrate qualifications of testing personnel, pass on-site inspections, perform satisfactorily on proficiency test samples, and meet specified quality assurance standards.     

Do we need to accredit proficiency testing schemes?

 Proficiency testing (PT) is being increasingly used as an important quality assurance tool for laboratories. The subject of quality of the providers of PT schemes has been discussed increasingly in recent years. Some countries have implemented systems for the accreditation of PT schemes. This paper looks at the background to the accreditation of PT schemes, the likely mechanisms which could be employed for accreditation, and some of the practical aspects.     

Internal audits in private medical laboratory practice – a Finnish experience in 1996–2000

Internal audits inherently effect quality improvement, and concrete results can be expected by careful planning. As audits should improve the quality system in situ, the development of audits should not be neglected. ISO/IEC 17025 describes the objectives of internal audits and management reviews in more detail compared to the former standards EN 45001 and ISO/IEC Guide 25, although the main features are unchanged. This addresses continuous surveillance of the current practice. A brief questionnaire on vertical audits was distributed to 74 of 120 employees at a Finnish private medical laboratory, Medix Laboratories Ltd. A positive feed-back was received from the current management of audits. However, the study revealed that continuous supervision of audits is needed. Many employees were not willing to perform audits if they had no previous experience. Additionally, audits performed at the workbench were not considered as the best possible for fruitful discussions. Received: 20 February 2001 Accepted: 30 November 2001     

Addressing issues associated with the development and management of PT programs and with their optimum use

Over 200 participants from 54 countries took part in working group (WG) discussions on proficiency testing (PT) held in conjunction with the Global Odyssey 2002 conference on 24–26 February, 2002 in Atlanta, Georgia, USA. Each WG addressed a series of questions focusing on the role of PT in laboratory quality management (WG1), alternatives to traditional PT (WG2), international aspects of PT programs (WG3), quality management of PT programs (WG4), how to assess laboratory performance (WG5), and developing and funding PT for resource-limited countries and regions (WG6). Each large WG was further subdivided into smaller groups to allow maximum participation, which was one objective of the WGs. Some subgroups addressed the same questions, but in most cases they drew very similar conclusions. Individual participants were surprised to discover the truly global nature of some problems with PT, while at the same time how specific differences among countries or regions can either enhance or hinder opportunities to implement PT programs. Received: 13 April 2002 Accepted: 25 April 2002     

Accreditation of PT providers – is it worth the money?

This topic is being presented from two perspectives, namely the views of an accreditation body and those of an accredited provider of external quality assessment schemes. The first perspective, from an accreditation body, is based on the experience of Australia's national laboratory accreditation body (NATA), which has accredited fourteen proficiency testing (PT) providers and is currently processing an application from another. The second perspective is based on the experience of EQUALIS, the national quality assurance organisation for laboratory medicine in Sweden, which was granted accreditation in 2002.Presented at 5^th Eurachem Workshop on Proficiency testing in analytical chemistry, microbiology and laboratory medicine, Portorož (Slovenia) 25–27 Sept 2005     

The Italian way: Accreditation and continuous quality improvement in clinical laboratories

 The transition from quality assurance of the analytical phase to the quality management of total testing in clinical laboratories is still at an early stage. But it has begun. Accreditation through voluntary, educational and professional schemes, like the Clinical Pathology Accreditation scheme, is a useful tool for following defined standards of practice and having these independently confirmed on the basis of a peer review. Approved clinical laboratories can obtain a hallmark of performance and offer reassurance to users of their services. However, accreditation does not guarantee an error-free service; it is not the final step, but an important stage in the improvement process. Quality is a journey and continuous quality improvement is the paradigm for better addressing our efforts to satisfy customers' expectations for the desired health outcomes related to a high-quality laboratory service.     

The Swiss External Quality Assessment Scheme in Bacteriology and Mycology 1992–1996

 The Swiss External Quality Assessment Scheme in Bacteriology and Mycology was created in 1980 and has been organised since 1983 by the Department of Medical Microbiology in Zurich. The number of Swiss participants has steadily risen from 66 in 1989 to 92 in 1996. Twelve bacterial and fungal strains are sent to the participants in four despatches, each containing three specimens, per year. Scores are allocated per specimen and range between 0 and 1. Participants with mean scores of ≤0.75 are considered poor performers. The mean scores increased from 0.85 in 1992 to 0.91 in 1996. This improvement can be attributed to the educational effect of the external quality control scheme, since all participants receive a detailed discussion for each specimen together with their individual results. On average, both large University and Cantonal (state) laboratories as well as private laboratories show satisfactory performance. In particular, laboratories officially recognised by the Swiss Federal Office of Public Health (SFOPH) rate better than non-recognised participants. Many small regional hospital laboratories, most of them not SFOPH-recognised, are often among the poor performers. They are often managed by technical staff and lack a trained microbiologist. The recently introduced legislation in Switzerland renders participation in external quality assessment schemes compulsory, and all clinical microbiology laboratories are required to employ qualified microbiologists. This will certainly help to improve the quality standards of all laboratories performing microbiological tests. Received: 13 November 1997 · Accepted: 28 December 1997     

Interlinkages and recognition of proficiency-testing schemes

 Because proficiency testing (PT) is increasingly used for the accreditation of testing laboratories and as a tool for backing up existing multilateral recognition arrangements between accreditation bodies, the question of performance and comparability of the proficiency-test providers arises. In this paper different approaches to assess the equivalence of European PT schemes and the competence of their providers are presented. As a first step a workshop is proposed to agree on a pilot study. The final aim is to create confidence in the existing PT schemes in Europe and to use them as common European tools.     

Quality issues in proficiency testing

 Proficiency testing is a means of assessing the ability of laboratories to competently perform specific tests and/or measurements. It supplements a laboratory's own internal quality control procedure by providing an additional external audit of their testing capability and provides laboratories with a sound basis for continuous improvement. It is also a means towards achieving comparability of measurement between laboratories. Participation is one of the few ways in which a laboratory can compare its performance with that of other laboratories. Good performance in proficiency testing schemes provides independent evidence and hence reassurance to the laboratory and its clients that its procedures, test methods and other laboratory operations are under control. For test results to have any credibility, they must be traceable to a standard of measurement, preferably in terms of SI units, and must be accompanied by a statement of uncertainty. Analytical chemists are coming to realise that this is just as true in their field as it is for physical measurements, and applies equally to proficiency testing results and laboratory test reports. Recent approaches toward ensuring the quality and comparability of proficiency testing schemes and the means of evaluating proficiency test results are described. These have led to the drafting of guidelines and subsequently to the development of international requirements for the competence of scheme providers. Received: 2 January 1999 · Accepted: 7 April 1999     

Proficiency testing in occupational and environmental health – Current practice and international initiatives for harmonisation

An increasing number of proficiency testing schemes (PT schemes) related to occupational and environmental health have been organised. Most schemes emphasise the importance of the validation of analytical results. With regards to harmonisation of the schemes, there are many differences between the schemes at many levels. These include factors concerning their relationship with legislation, national status, type and quality of proficiency testing material, analytical range and priorities for future development. Since differences between PT schemes have been recognised at the European level by organisers of PT schemes and external quality assessment schemes (EQASs) it seems appropriate to reinforce collaboration between scheme organisers in order to improve the quality of analytical performance in occupational and environmental health.     

Quality assurance in the microbiology laboratory

 The pertinent issues necessary for the establishment of quality assurance in the microbiology laboratory are discussed. Quality assurance is a planned system of control measures that enables management to ensure that the analytical data produced in the laboratory are valid. To introduce quality assurance, all activities in the laboratory that affect the production of analytical data must be documented and controlled. These include sampling, method selection, laboratory environment, equipment, reagents and media, staff, reference materials and internal and external quality control. Laboratory accrediation in accordance with EN45001 and ISO Guide 25 enables laboratories demonstrate to an external agency their ability to perform analytical work and produce valid analytical data. This gives creditability to the laboratory and allows management to have confidence in the data produced. Received: 6 June 1995 Accepted: 3 July 1995