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Shin S, Yu S, Cho EJ, Shin KH, Chung JW, Kim S, Yoo SJ. Delta check limits for thyroid function tests adjusted for clinical settings. Clin Chim Acta 2024; 561:119847. [PMID: 38969088 DOI: 10.1016/j.cca.2024.119847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND This study aimed to determine practical delta check limits (DCLs) for thyroid function tests (TFTs) to detect sample misidentifications across various clinical settings. METHODS Between 2020 and 2022, 610,437 paired TFT results were collected from six university hospitals. The absolute DCL (absDCL) was determined using the 95th percentile for each clinical setting from a random 60 % of the total data. These absDCLs were then tested within and across different settings using the remaining 40 % of the data, alongside mix-up datasets for result and sample comparisons. The sensitivities of absDCL were calculated within and across groups in the mix-up datasets. RESULTS Health screening absDCLs were notably lower than in other settings (2.58 vs. 5.93-7.08 for thyroid-stimulating hormone; 4.12 vs. 8.24-10.04 for free thyroxine; 0.49 vs. 0.82-0.91 for total triiodothyronine). The proportion of results exceeding absDCL of health screening differed from those of other clinical settings. Furthermore, sensitivity between health screening and other clinical settings was significantly different in both the result mix-up and sample mix-up datasets. CONCLUSIONS This study determined practical DCLs for TFTs and highlighted differences in absDCLs between health screening and other settings. These findings emphasize the importance of tailored DCLs in improving the accurate reporting of TFTs.
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Affiliation(s)
- Sunghwan Shin
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
| | - Shinae Yu
- Department of Laboratory Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Eun-Jung Cho
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
| | - Kyung-Hwa Shin
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University and Pusan National University Hospital, Busan, Republic of Korea.
| | - Jae-Woo Chung
- Departments of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
| | - Sollip Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Soo Jin Yoo
- Department of Laboratory Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
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Loh TP, Tan RZ, Sethi SK, Lim CY, Markus C. Delta checks. Adv Clin Chem 2023; 115:175-203. [PMID: 37673520 DOI: 10.1016/bs.acc.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Delta check is an electronic error detection tool. It compares the difference in sequential results within a patient against a predefined limit, and when exceeded, the delta check rule is considered triggered. The patient results should be withheld for review and troubleshooting before releasing to the clinical team for patient management. Delta check was initially developed as a tool to detect wrong-blood-in-tube (sample misidentification) errors. It is now applied to detect errors more broadly within the total testing process. Recent advancements in the theoretical understanding of delta check has allowed for more precise application of this tool to achieve the desired clinical performance and operational set up. In this Chapter, we review the different pre-implementation considerations, the foundation concepts of delta check, the process of setting up key delta check parameters, performance verification and troubleshooting of a delta check flag.
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Affiliation(s)
- Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - Rui Zhen Tan
- Engineering Cluster, Singapore Institute of Technology, Singapore
| | - Sunil Kumar Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Chun Yee Lim
- Engineering Cluster, Singapore Institute of Technology, Singapore
| | - Corey Markus
- Flinders University International Centre for Point-of-Care Testing, College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
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Jokic A, Rimac V, Vlasic Tanaskovic J, Podolar S, Honovic L, Lenicek Krleza J. The concurrence of the current postanalytical phase management with the national recommendations: a survey of the Working Group for Postanalytics of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2021; 31:030704. [PMID: 34658645 PMCID: PMC8495617 DOI: 10.11613/bm.2021.030704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/01/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction The detection and prevention of errors in the postanalytical phase can be done through the harmonization and standardization of constituent parts of this phase of laboratory work. The aim was to investigate how well the ongoing management of the postanalytical phase corresponds to the document “Post-analytical laboratory work: national recommendations” in Croatian medical biochemistry laboratories (MBLs). Materials and methods All 195 MBLs participating in the national external quality assessment scheme, were invited to undertake a part in a survey. Through 23 questions the participants were asked about management of the reference intervals (RI), delta check, reflex/reflective testing, postanalytical quality indicators and other parts of the postanalytical phase recommended in the national recommendations. The results are presented in numbers and percentages. Results Out of 195 MBLs, 119 participated in the survey, giving a response rate of 61%. Not all of the respondents provided answers to all the questions. Delta check has not been used in 59% (70/118) of the laboratories. Only 22/113 (20%) laboratories use reflex and/or reflective testing. In 53% of the laboratories, critical results were reported within 30 minutes of the confirmation of the results. In 34% (40/118) of the laboratories, turnaround time and reporting of critical results are two most often monitored postanalytical quality indicators. Conclusion The results showed the critical results reporting and monitoring of postanalytical quality indicators are in the line with the recommendations. However, the management of RI verification, the use of delta check and reflex/reflective testing still must be harmonized among Croatian MBLs.
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Affiliation(s)
- Anja Jokic
- Department of Medical Biochemistry, Hematology and Coagulation with Cytology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia.,Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
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Aziz Ali A, Khalid A, Moiz B. Performance evaluation of delta checks for error control in a hematology laboratory. Int J Lab Hematol 2020; 43:e118-e121. [PMID: 33222421 DOI: 10.1111/ijlh.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Bushra Moiz
- Aga Khan University Hospital, Karachi, Pakistan
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Abstract
Delta checks are a post-analytical verification tool that compare the difference in sequential laboratory results belonging to the same patient against a predefined limit. This unique quality tool highlights a potential error at the individual patient level. A difference in sequential laboratory results that exceeds the predefined limit is considered likely to contain an error that requires further investigation that can be time and resource intensive. This may cause a delay in the provision of the result to the healthcare provider or entail recollection of the patient sample. Delta checks have been used primarily to detect sample misidentification (sample mix-up, wrong blood in tube), and recent advancements in laboratory medicine, including the adoption of protocolized procedures, information technology and automation in the total testing process, have significantly reduced the prevalence of such errors. As such, delta check rules need to be selected carefully to balance the clinical risk of these errors and the need to maintain operational efficiency. Historically, delta check rules have been set by professional opinion based on reference change values (biological variation) or the published literature. Delta check rules implemented in this manner may not inform laboratory practitioners of their real-world performance. This review discusses several evidence-based approaches to the optimal setting of delta check rules that directly inform the laboratory practitioner of the error detection capabilities of the selected rules. Subsequent verification of workflow for the selected delta check rules is also discussed. This review is intended to provide practical assistance to laboratories in setting evidence-based delta check rules that best suits their local operational and clinical needs.
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Affiliation(s)
- Corey Markus
- Metabolic Laboratory, Genetics and Molecular Pathology Directorate, SA Pathology, Women's and Children's Hospital Site, Adelaide, Australia
| | - Rui Zhen Tan
- Engineering Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
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