The Westgard Rules

Lab Week Winners

Posted by Sten Westgard, MS

I just wanted to let you know our Lab Week contest/raffle is over. We selected five winners at random from among all the entries. These hard working laboratory professionals will receive free registration to our latest online course:

• Dr. Ian Brincat, Mater Dei Hospital, Malta
• Anna Nelson, Family Health Center, Worcester, Massachusetts
• Dr. Bert Peeters, Belgium
• Patricia Seegmiller, Huntington Internal Medicine Group, West Virginia
• Maria Elena Redin Sarasola, Navarra, Spain

Here's what they won - free registration to the new online training course:

Quality Management and Design of Analytical Systems, an Introduction

This course provides the background for understanding QC Design, with emphasis on available guidelines, quality goals, QC Design tools, and practical directions concerning the information needed to perform QC Design.

Congratulations again to the winners. Thanks also to all the other professionals who entered. We appreciate your time and your suggestions.

Stay tuned - we'll run another contest like this again soon.

What Doctors know, part two, ...

Posted by Sten Westgard, MS

Following up on the previous post on what doctors know about laboratory testing, here's another survey plumbing the depths of their knowledge. This study is a survey of general practitioners, intern doctors, and medical students in Spain:

The degree of knowledge shown by physicians in relation to the variability of laboratory test results.
Emilio Flores, Maria Leiva, Carlos Leiva-Salinas and Maria Salinas
Clin Chem Lab Med 2009;47(3):381-382.

What do you think they found?

Lab Week Prize: Free course registrations

By Sten Westgard, MS

In celebration of Laboratory Week 2009, we'll be giving away (a limited number of ) free registrations to our new and upcoming online course.

Quality Management and Design of Analytical Systems, an Introduction

This course provides the background for understanding QC Design, with emphasis on available guidelines, quality goals, QC Design tools, and practical directions concerning the information needed to perform QC Design.

If you're interested, here's how to include yourself in the running...

Happy Lab Week!

Posted by Sten Westgard, MS

It's that one week a year where overworked, underpraised laboratory professionals try to get a little more recognition from everyone else.

Dr. Westgard likes to say that we don't need an entire Laboratory Week, we just need one day. A one day Laboratory Holiday, where all of those tests that everyone relies on are unavailable. The day a doctor can't get a test done because there is no laboratory to do the test - that's the day the clinician begins to respect laboratory professionals.

But of course that will never happen. Laboratory professionals are too important (some say Vital). There's no time off and our strong professional ethics are committed to service. Like air traffic controllers, laboratory professionals are hidden but critically central to the entire practice.

I hope that we do this throughout the year, but just to be clear: We thank you - the laboratory professional - for your hard work and your dedication. We're here for you.

A Quality Indicator for Analytical Quality?

Posted by Sten Westgard, MS

Some recent articles on the subject of Quality Indicators have reminded me that analytical quality is to laboratory management much like the laboratory is to the hospital: over-worked, under-appreciated, and assumed to be of reliably excellent quality.

• Laboratory Medicine Quality Indicators: A Review of the Literature, Shahram Shahangian, PhD, MS, and Susan R. Snyder, PhD, MBA, Am J Clin Pathol 2009;131:418-431
• A Summary of Deliberations on Strategic Planning for Continuous Quality Improvement in Laboratory Medicine, Dana Marie Grzybicki, MD, PhD, Shahram Shahangian, PhD, Anne M. Pollock and Stephen S. Raab, MD. Am J Clin Pathol 2009;131:315-320.

PFP vs. P4P: Physicians Foment and Protest against Pay for Performance

Posted by Sten Westgard, MS

This week two Harvard doctors wrote an op-ed for the Wall Street Journal: Why 'Quality' care is dangerous (subscription may be required, depending on time of access). In this essay, they warn of the dangers of what they term the "quality metrics" that provide the basis for "pay-for-performance" systems that may govern physician reimbursement. Under any of the proposed healthcare reforms, P4P schemes may be used as a way to "incentivize" doctors and clinicians to provide the right care to their patients.

What's New: April 2009

CHANGE IS COMING TO WESTGARD WEB

We wanted to give you a heads-up on future changes that will be made to the layout and operation of Westgard Web.

Don't Panic.

http://www.westgard.com/changeiscoming.htm

ESSAY: Out-of-control in North Dakota 

Dr. Westgard returned to his birthplace in March.
Reflecting on events there more than half a century ago, as well as the terrible floods of more recent times, Dr. Westgard writes that both path and present call us to quality.

http://www.westgard.com/essay126.htm

SIGMA METRIC ANALYSIS: Sysmex xt 1800i

A poster at the IFCC conference applied Sigma-metric analysis to a number of hematology methods, including differential parameters, on the Sysmex xt 1800i. Interestingly, they chose Biologic-based quality requirements, not the usual CLIA goals. We review the data and generate some graphic analysis.

http://www.westgard.com/qcapp56.htm

SIGMA QC DESIGN: "Westgard Rules" and Levey-Jennings Charts

Based on the Sigma-analysis of the Sysmex xt 1800i, we apply QC Design principles and analyze the different QC procedures
appropriate for different quality requirements.

http://www.westgard.com/qcapp57.htm

IN MEMORIAM: Ron Laessig, PhD

We note with sadness the passing of a giant in laboratory medicine.

http://www.westgard.com/ronlaessig.htm

What Doctors know...

Posted by Sten Westgard, BS

I've been meaning to draw attention to a paper from last year's Annals of Clinical Biochemstry for some time. Now's the moment:

"Learning needs in clinical biochemistry for doctors in foundation years" Victoria Khromova and Trevor A Gray, Ann Clin Biochem 2008; 45; 33-38. (subscription required)

The authors conducted a small survey of postgraduate doctors at the Sheffield Teaching Hospitals in the UK, in their foundation years (similar to the residency years of postgraduate doctors in the US). This study asked the doctors if they were confident about ordering 12 different types of tests (for example, proteins, calcium, lipid profile, urea and electrolytes). Then they also asked the doctors if they were confident about interpreting the results of those same 12 different types of tests.

It's worth looking at the results in detail of the actual paper, but let's summarize by saying those results are not ideal. While it's probably not surprising to find that the doctors felt more confident in ordering the tests than in interpreting the results, it's concerning to see the extent of their uncertainty. What does it mean when a doctor is only "usually confident" or not confident about requesting a test? Are they placing that test order just because other doctors do it? Are they ignorant of the utility of the test?

It is very striking that the study reports "18% of doctors were confident in requesting tests that they were not confident in interpreting." This is quite the bravado: I don't know how to interpret the results, but I have no problem ordering the test.

I don't think this is a particular reflection on UK doctors. If such a study was conducted somewhere else, I would expect similar, maybe even worse, results. Doctors tend to learn by doing about test results, but a certain number of tests seem to get ordered defensively or simply out of tradition.

This is another example where the laboratory can provide additional value - not only report the numbers, but help interpret the results, and perhaps even suggest what other tests might be a good idea to order next.