Tools, Technologies and Training for Healthcare Laboratories

The 2021 QC Survey Results for Chemistry

The 2021 Global QC Survey practices reveal unique practices in the biochemistry sections of labs around the world.

 The 2021 Chemistry Global QC Survey Results

Sten Westgard, MS
December 2021


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

Are chemistry laboratories stuck in the past with antique QC practices?

 2021 qc survey chemistry q8 2sds

Two-thirds of labs are still reporting the use of single ranges on all of their tests. The tradition of using 2 sd control limits was born in chemistry testing nearly half a century ago, so maybe it's not so surprising that the practice endures.

 2021 qc survey chemistry q9 westgardrules

More than 90% of the chemistry sections use "Westgard Rules" on some or all of their tests. Globally, very very few chemistry tests go without Westgard Rules.

 2021 qc survey chemistry q10 chart setup

Almost two-thirds of laboratories establish their own mean and SD. Over half are also using manufacturer ranges. Only about 10% of labs are using measurement uncertainty to set their ranges. One of the least-used approaches is their own professional judgment.

 2021 qc survey chemistry q11 chart regulations

ISO 15189 maintains its global dominance as the most influential standard for setting up chemistry control charts. 

2021 qc survey chemistry q12 control types

The use of manufacturer controls are very high. Assayed controls are the 2nd and 3rd most popular types.

 2021 qc survey chemistry q13 average of normals

 Nearly 70% of chemistry sections are not using any patient data techniques (commonly called PBRTQC these days).

The Real Practice of Running Controls

 2021 qc survey chemistry q14 qc frequency

 Once-a-day QC is the practice of a majority of chemistry sections. Running twice a day is common for almost 30% of laboratories.

 2021 qc survey chemistry q15 troubleshooting

The good news for chemistry sections, 3 out of 4 try to troubleshoot first, repeat second. However, only a slightly smaller percentage also admit to repeats. A majority run a new control after the first repeat. That a quarter of laboratories will consider recalibrating as a first responses is a boon to the makers of calibration kits, but might not be an efficient practice for the world.

 2021 qc survey chemistry q16 ooc frequency

78% of chemistry sections see errors every week, every day, or even more often. Chemistry seems to be very error prone.

 2021 qc survey chemistry q17 patient resting policy

Retesting all patients, while the theoretical response to an out-of-control situation, is only practiced by a third of chemistry sections. Equally practiced is the policy of testing small groups of patients near the rejection time, proceeding backwards until the error is found.

 2021 qc survey chemistry q18 override

Almost 1 in 8 chemistry sections has to regularly (daily or weekly) override their QC results to release patient results.

The Final Overview

 2021 qc survey chemistry q19 manage costs

A majority of chemistry sections have taken no actions to change their QC practices or manage their costs. The most popular actions, for those who took some action, was to reduce QC frequency or consolidate to fewer controls.