BACKGROUND

In 2001 the Commonwealth Department of Health and Ageing sought proposals to undertake an evaluation of Australian pathology laboratory accreditation arrangements. This was the first comprehensive evaluation since the introduction of accreditation in 1986. This research resulted in the 2002 Corrs Chambers Westgarth report ‘Evaluation of the Australian Pathology Laboratory Accreditation Arrangements’.

Recommendations from that report included 5.1 ‘That the DHA and HIC seek the cooperation of the RCPA QAP to establish explicit external quality assurance performance criteria, initially in chemical pathology and gynaecological cytology, and a mechanism for the RCPA QAP to identify relatively poorly performing laboratories.’

From this recommendation, RCPA and RCPA QAP established the first KPI project. Key Performance Indicators were setup for Chemical Pathology and Cytopathology with the intention that it could be used as an ‘Early Warning system’ to identify poorly performing laboratories. In collaboration with NATA, Peer Review Committees were established by NATA to review the limited KPI data. It had been intended that a peer review process would be established on an ongoing basis and used as a flag to notify NATA that a laboratory required some form of review. This would have been in keeping with Recommendation 5.2 from the Corrs Chambers Westgarth report, which stated ‘That RCPA QAP and other external quality assurance providers regularly submit to NATA reports identifying laboratories that are poorly performing according to these agreed performance criteria.’

Conclusions from the KPI review process included:

• Chemical Pathology – the KPIs and Peer Review Committee process can identify laboratories with poor EQA performance but this does not necessarily equate to poor ratings at on‐site assessment, and therefore, the Steering Committee could not recommend the introduction of KPIs in Chemical Pathology as a formal tool enshrined in NPAAC Standards to help identify poorly performing laboratories.
• Gynaecological Cytopathology – KPIs are not a valid tool to use for identifying poorly performing laboratories and therefore, it was recommended that they not be implemented in the existing format. However, it was thought a large number of Major Errors in a QAP may be a trigger for a review of some variety.

As part of its continual assessment and monitoring program to increase the competency of pathology laboratories and patient safety, Royal College of Pathologists of Australasia (RCPA) Quality Assurance Programs Pty Ltd (QAP) sought QUPP funding for the Role of External Quality Assurance in Identifying Poor Laboratory Performance project. This project is consistent with the DoHA 2009 Budget initiative “to continue the development of key performance indicators and other risk identifiers in pathology service provision”.¹