Tools, Technologies and Training for Healthcare Laboratories

The 2021 Middle-East QC Survey Results

Is QC in the Middle-East above average? Are the practices there exceeding the global usual? Or are they worse than the rest of the world? The results are in.

 The 2021 Middle-East QC Survey Results

Sten Westgard, MS
November 2021

2021 QC Survey Middle East Map

[This survey was completed with the support and partnership of Technopath Clinical Diagnostics.]

We took a look at all the QC practices in the Middle-East. Let's start by describing the respondents.

The demographics

  2021 middle east Q3 lab type

There's an interesting mix between public and private hospitals in the Middle-East, as well as swiftly growing reference lab networks.

2021 middle east Q4 lab volume

Very few small labs in the area participated in this study. There is a peak number of what we might call "mid-sized" modest laboratories in the region.

 2021 middle east Q5 lab regulations

CAP accreditation has a very high profile in the Middle-East, almost as high as in the USA itself.

2021 middle east Q7 testing focus

The overwhelming focus of the survey responses is on chemistry testing.

Now, how do these labs practice QC?

The QC Set Up

2021 middle east Q8 2 sd

Nearly two out of three labs are using ranges like 2 standard deviations as one of their primary QC techniques. This is less than what we see in the US, and even better, almost 10% of labs have abolished this practice.

 2021 middle east Q9 westgard rules

"Westgard Rules" are very strong in the Middle-East. And the only region where there are no labs that report not using "Westgard Rules". Almost 20% more of labs in this area use Westgard Rules on all their tests vs. what happens in the US. This may be where "Westgard Rules" are used more than anywhere else in the world. 

 2021 middle east Q10 range setting

Nearly half of labs calculate the actual mean and the actual SD to create their Levey-Jennings control charts, significantly lower than what we see as the global average and the USA. There is also a higher use of manufacturer ranges.

 2021 middle east Q11 range regulations

Another way the region stands out uniquely is the influence of the Westgard website, which is actually stronger than most of the regulatory and accreditation bodies. CAP has a very strong influence here. ISO 15189 plays less of an importance here than we see in other regions (with the exception of the USA).

 2021 middle east Q12 control types

The use of manufacturer controls is still high in this area. Third party assayed liquid controls are very popular, too. Unassayed controls are very unpopular here.

 2021 middle east Q13 moving averages

Almost 2 labs out of 3  do not use any PBRTQC. But more than 30% report they are using it for at least a few tests. This may be the part of the world where the most PBRTQC is being performed.

The Real Practice of Running Controls

 2021 middle east Q14 qc frequency

There are more "twice a day" labs and many fewer "three a day" labs in the Middle-East. The once-a-day frequency is about the same as the global average. .

 2021 middle east Q15 troubleshooting

Over 70% of labs in the Middle-East repeat the control when it's out. Over half will run a new control after the repeat. At the same time, an equal percentage say that they troubleshoot and seek the root cause when they get an out-of-control result. .

 2021 middle east Q16 ooc frequency

Only 13% of labs report being out of control once a day or more than once a day, significantly less than the global average, and even more significantly less than the US (half the rate!). The positive take on this is to hope that labs here are finding better ways to prevent errors from happening. The pessimist view on this would be that there may be errors going undetected instead.

 2021 middle east Q17 retesting

The Middle East re-runs all patients at a higher rate than the global average and labs in the US.

2021 middle east Q18 override.

Labs are three times more like to override their QC and report patients than what is reported for the US. But that's still a bit lower than the global average.

The Final Overview

 2021 middle east Q19 qc costs

Despite all these instances of outstanding practices, nearly three-quarters of labs have not made any meaningful changes to reduce their QC costs. Very few changes are being made to control limits, rules, and QC materials. While a lot of good things are being done in the Middle-East, there are many more opportunities to do even better.