Quality Indicator Measures as It Affects Turnaround Time (TAT) in A Molecular Laboratory in Port Harcourt, Rivers State

Abstract

Background: Turnaround Time (TAT) is an important Quality Indicator in the medical laboratory. The Rivers State University Teaching Hospital (RSUTH) Polymerase Chain Reaction (PCR) laboratory was enrolled in the process of World Health Organisation (WHO) - Regional Office for Africa (AFRO) accreditation by FHi360 in preparation for the ISO 15189 accreditation in 2016. One of the services rendered in the laboratory is Early Infant Diagnosis (EID)/Dried Blood Spots (DBS) in Human Immunodeficiency Virus (HIV) exposed infants. Clinicians depend on these results to determine the next step for the management of HIV exposed Infants. This study is aimed at assessing the rate of sample rejection (SR), determine the effect of specific intervention on this rate and the effect of SR on TAT. Method: It involves the assessment of samples delivered to the RSUTH PCR Laboratory from January 2019 to March 2020. A baseline rate of sample rejection was established from January to July 2019. Interventional measures were put in place such as introducing the national algorithm for rejection and acceptance of samples, training was also done for EID sample collectors and a final assessment of changes in the rate of sample rejection was determined at the final period of January to March 2020.Results: During the baseline period, sample rejection rate started at 5% in February and went back to 0% in March. In April however, the rate of rejection increased to 9%. There was a decline in rejection rate to 5% and 7% in May and June respectively. A sudden spike in rejection occurred in July at a rate of 19%. The major reasons for sample rejection were DBS cards with insufficient blood spots, DBS cards with clots present in spots, DBS cards that have serum rings and grossly haemolysed DBS. After baseline data was collected and interventions put in place. Sample rejection rate drastically reduced to 1%, 0% and 0% respectively from January to March which is way below the maximum threshold of 2% as advocated by WHO. At baseline EID, TAT was longer than a month, however; with SR, the TAT increased to about seven weeks. The final assessment in March from this study showed a significant reduction in sample rejection to 0%.Conclusion and recommendations: This study has shown that quality improvement is achievable if interventional tools are utilized promptly. This will result in shorter TAT; fewer samples rejected and therefore prompt treatment of exposed infants thus reducing morbidity and mortality due to HIV.