In my first post Are you proficient in proficiency testing? We explored some tips to help you master the Proficiency Testing process. But now you’ve run your PT test just as a patient specimen, filled out your reporting form carefully, submitted your testing results to the PT provider, and unfortunately the results were not what you were expecting.

Don’t be discouraged. There are a number of things you can do to assess your performance and identify areas to improve your laboratory testing process and procedure. While the results may not have been what you had hoped for, it’s an opportunity to improve and enhance quality of patient care.

Investigate the root cause of unsatisfactory results.

When the graded PT results are received, all unsatisfactory results (those achieving a grade of <80%) must be investigated and a root cause must be determined.  This investigation should be documented and retained until the next biennial accreditation inspection.

I strongly recommend that this investigation be performed in any situation where a testing result comparable to the peer group was not obtained.  A score of 80% on any particular analyte can lead to a satisfactory score, but any results that led to the lab not achieving 100% should be investigated to determine the source of the error.

Perform a prompt, in-depth, investigation in event of an unsuccessful PT performance.

In the event of unsuccessful PT performance, where 2 out of 3 PT events are unsatisfactory, it is essential that a thorough investigation be performed and the problem(s) are identified and resolved.  Under CLIA regulations, unsuccessful PT can lead to a cease testing order for a six month period for the analyte(s) in question. A swift and prompt investigation and resolution are necessary.

Explore all errors, including clerical errors, to address any potential patient impact.

All clerical/documentation errors should be considered significant and not dismissed as “just” a clerical error.  These clerical errors should alert you to the possibility of similar errors occurring in the reporting of patient results. These post-analytic clerical errors could lead to significant adverse patient outcomes.

Investigate ungraded PT results to identify problems with particular testing kits and methodologies that may affect your testing results.

Frequently the PT provider will assign a score of “100%” to ungraded specimens, but there will be a footnote indicating they have actually not been graded. Usually, ungraded specimens occur because either there is no consensus among laboratories submitting results or the referee laboratories were not able to agree on the result.

In the case of ungraded specimens, there should be evaluation of your results to determine how you did in comparison to other laboratories.  These are important to review because, at times, information is present indicating problems with a particular kit/methodology which might have an impact on your laboratory.

Retain all documentation related to PT.

All documents related to PT must be retained for at least two years.  This includes the paperwork which is sent with the unknown challenges, any instrument printouts, work sheets, signed attestation statement, results and investigation of any issues, and evidence of review by technical staff and Laboratory Director.

Consider diversifying your PT providers

Many Laboratory Directors oversee more than one laboratory.  As we mentioned in part one of this series, it is imperative that all enrollment forms, testing materials, testing results be kept segregated for each laboratory and that there is no evidence of communication regarding these results between laboratories.

If you direct more than one similar type laboratory, you might consider obtaining the PT for each individual laboratory from a different PT provider so that there is no question of collusion between the laboratories in submission of the PT results.

I hope you find one or more of these points helpful in assessing your laboratory’s performance after an unsuccessful or unsatisfactory PT experience. Remember, PT helps us to provide positive patient outcomes by ensuring that our laboratory results are accurate and reliable.