Evaluation of the effectiveness of internal quality control of medical care during control and supervision activities in medical organizations

Introduction. Currently, medical organizations of Moscow Healthcare Department have a three-level system of internal control for assessing the quality and safety of medical activities. At the same time, insurance companies have adopted a logically consistent, alternating multi-level system of inspections (medical and economic control) and evaluations (medical and economic evaluation, quality of medical care evaluation). Methods, techniques, criteria and guidelines for external and internal control of the quality and safety of medical activities are different. In this regard, assessment of the effectiveness of internal quality control of medical care in medical organizations during control and supervision activities is an important task that requires an evidence-based decision. Objectives. To provide evidence for the effectiveness of assessment criteria when conducting internal quality control of medical care and to determine their impact on effective performance of medical organizations. Materials and methods. The authors studied the results of 10 inspections and 36 evaluations of regulatory and supervisory authorities (insurance companies, Federal Service for Surveillance in Healthcare (Roszdravnadzor), etc.) and systematized the reasons for applying deductions and penalties. We performed a comparative analysis with evaluation criteria used by the heads of structural divisions (departments, laboratories) of City Clinical Hospital named after brothers Bakhrushin of Moscow Healthcare Department, as well as other private medical organizations. Authors studied technical capabilities of various automated information systems (Megaclinic, Asklepius, Doctor’s Automated Workstation, EMIAS for polyclinics and hospitals, etc.). Results. Authors performed comparative analysis of criteria used in inspections and evaluations of external and internal control of the quality and safety of medical activities. Analysis showed that the currently used assessment criteria do not fully ensure fulfillment of requirements and guidelines, violation of which entails financial sanctions (deductions, fines). Conclusion. It is necessary to develop and implement methods for organizing and conducting internal control of quality and safety of medical activities to create «effective criteria» that will minimize financial sanctions (deductions, fines) applied during various inspections (evaluations) of control and supervisory authorities.

Convenience of Hgb-O detected by optical method in XN-series hematology analyzers in evaluating hemoglobin concentration in samples with chylous turbidity

The chylous turbidity of blood samples is one of the causes of false-high hemoglobin (Hgb) concentration measurements by the colorimetric method, which has been widely applied in hematology analyzers. In such cases, additional manual procedures are required to correct Hgb concentrations. We therefore examined the effectiveness of an optical method for measuring Hgb concentrations in samples with chylous turbidity using Hgb-O in the reticulocyte channel equipped in XN-series analyzers (Sysmex, Kobe, Japan). Hgb-O showed excellent basic performance, including linear correlation and invariability with sodium lauryl sulfate (SLS)-Hgb detected by the colorimetric method. In the analysis of samples from healthy volunteers supplemented with fat emulsion, chylous turbidity did not affect Hgb-O but SLS-Hgb, which was falsely increased according to the dose of fat emulsion. Actually, SLS-Hgb was falsely elevated in 34 of 40 chylous turbidity 3+ samples. The remaining 6 samples were measured in hematology analyzers where Hgb-O was inconsistent with SLS-Hgb in the internal quality control records. For these samples, the correction factors calculated from the internal quality control records could contribute to providing the corrected Hgb-O value. These findings suggested that the optical method was effective and convenient for accurately evaluating Hgb concentrations in samples with extremely chylous turbidity.

Sigma Metrics: A Valuable Tool for Evaluating the Performance of Internal Quality Control in Laboratory

Background Six Sigma is a widely accepted quality management system that provides an objective assessment of analytical methods and instrumentation. Six Sigma scale typically runs from 0 to 6, with sigma value above 6 being considered adequate and 3 sigma being considered the minimal acceptable performance for a process. Methodology Sigma metrics of 10 biochemistry parameters, namely glucose, triglycerides, high-density lipoprotein (HDL), albumin, direct bilirubin, alanine transaminase, aspartate transaminase, urea nitrogen, creatinine and uric acid, and hematology parameters such as hemoglobin (Hb), total leucocyte count (TLC), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and platelet were calculated by analyzing internal quality control (IQC) data of 3 months (June–August 2019). Results Sigma value was found to be > 6 for triglyceride, HDL, Hb, TLC, and MCH, signifying excellent results and no further modification with respect to IQC. Sigma value was between 3 and 6 for glucose, albumin, creatinine, uric acid, PCV, and MCHC, implying the requirement of improvement in quality control (QC) processes. Sigma value of < 3 was seen in AST, ALT, direct bilirubin, urea nitrogen, platelet, and MCV, signifying suboptimal performance. Discussion Six Sigma provides a more quantitative framework for evaluating process performance with evidence for process improvement and describes how many sigmas fit within the tolerance limits.Thus, for parameters with sigma value < 3, duplicate testing of the sample along with three QCs three times a day may be used along with stringent Westgard rules for rejecting a run. Conclusion Sigma metrics help assess analytical methodologies and augment laboratory performance.

Internal quality control in blood and component bank in a tertiary healthcare center in Northern India

Quality control describes steps taken by blood and component bank to ensure that tests are performed correctly. Primary goal of quality control is transfusion of safe quality of blood. It is to ensure availability of efficient supply of blood and blood components. Internal quality control is the backbone of quality assurance program. To analyze the internal quality control of blood components in modern blood banking as an indicator of our blood bank performance. An observational cross sectional study conducted at the Blood and Component Bank, JN Medical College and Hospital from 2018 to 2020. Each blood component was arbitrarily chosen during the study on monthly basis. Selection criteria was 1.0% of total collection or minimum 4 bags per month. Packed red cells were evaluated for hemoglobin, hematocrit, RBC count; platelet concentrates for pH, yield and culture; fresh frozen plasma and cryoprecipitate were evaluated for unit volume, factor VIII and fibrinogen concentration. The mean HCT of packed red cells was 65.75+7.42%, volume was 238+26.25ml, Hb was 20.5+0.15g/dL and RBC count of 5.89x10+0.30x10. The mean platelet yield was 5.7x10, pH was ≥6.8+0.175 and volume was 82.5+13.75ml; cultures were negative and swirling was present in all the platelet units tested. Mean factor VIII and fibrinogen levels were found to be 95.25 +7.37and 307.5+41.37gm/l for FFP respectively. Mean volume, PT and APTT were 215+32.5ml, 14.15+0.325 sec and 29.50+1.5 sec respectively. The quality control of blood components ensures the timely availability of a blood component of high quality with maximum efficacy and minimal risk to potential recipients.

MAIN ASPECTS OF QUALITY CONTROL OF INTERNAL AUDIT OF ENTERPRISES

Introduction. The problem of internal audit quality control is extremely relevant for domestic industrial enterprises. This trend is explained by the fact that auditors as a result of the audit may come to an inaccurate conclusion and present erroneous results. Methods. This investigation is based on methods of analogies and theoretical generalization, system and structural-functional analysis, graphic, abstract and logical methods. Results. It is proved that an important stage of internal audit is the process of reporting on the results of internal auditors during the study of the actual state of the enterprise, according to which the internal auditor must establish the significance of the identified deficiencies. It is established that the assessment of control over the results of internal audit is carried out in order to ensure the senior management of the enterprise in obtaining quality services provided to the company by internal audit. It is investigated that the quality control of the conducted internal audit can be determined by testing in two areas: verification of compliance with existing regulations of audit procedures; detection of errors in the activities of structural units or in processes that were not prevented by the audit system. Identified aspects that should include the assessment of quality control of internal audit. The characteristics of the internal quality control of internal audit, which are based on internal and external evaluation, are highlighted. The importance of monitoring the follow-up after the internal quality control of internal audit is proved. Discussion. According to the research results, it is proved that an effective internal audit helps to solve problems related to the formation of a scientifically sound system of management decisions based on reliable information and timely optimal proposals for further measures to develop an industrial enterprise not only now but also in the long run. Keywords: internal audit, audit, financial and economic activities, quality control, evaluation, production and economic activities, enterprise.