Quality and the Total Testing Process

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Laboratory Medicine:
A National Status Report
Improving quality has been a core goal of the laboratory medicine sector for decades, beginning with proficiency testing (PT) in the 1930s.a Quality-related initiatives have been an important part of laboratory operations ever since.
A milestone in quality improvement occurred in 1986, when CDC hosted the first in a series of Institutes on Critical Issues in Health Laboratory Practice devoted to improving laboratory quality. Representatives assembled from diverse sectors within the health laboratory community including laboratorians, providers, public health practitioners, industry representatives, regulators, and payers. Participants defined the roles and responsibilities to be assumed in the processes associated with laboratory testing. At this critical meeting, participants were introduced to the concept of the total testing process (TTP), a systems-based framework for examining all possible interactions and activities that can affect the quality of laboratory tests.1 The aim of introducing the TTP was to design and implement interventions, restrictions, and limits that could reduce or eliminate errors that adversely affect testing and patient health outcomes.
Today, the TTP remains the conceptual framework for understanding the dynamics of laboratory medicine as well as quality measures to improve care. This chapter provides an overview of the TTP and examines the main types of error and other challenges to quality that occur in each phase.

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