Adjusting Quality Control Chart Limits for WBC, RBC, Hb, and PLT Counts to Reduce Daily Control Risks in Hospital Laboratory

Abstract

Background

To continuously improve medical quality and provide clinicians with more accurate blood test reports, this study collected blood quality control data in 2017 from a medical examination laboratory in a teaching level hospital located in Taoyuan City, Taiwan.

Material and Methods

The quality control data were arranged and analyzed from daily complete blood count (CBC), including white blood cells (WBC), red blood cells (RBC), hemoglobin (Hb), and platelets (PLT) recorded by a laboratory blood analyzer. Using the empirical Bayesian method, we estimated the variation of concentrations of the last and current batches to establish a novel control chart with adjusted upper and lower limits for the current batch, and then compared results with the traditional Shewhart method. The average run length (ARL) and sensitivity of the empirical Bayesian method were explored.

Results

The study found that ARL showed a qualified capability for the four blood routine tests when using the empirical Bayesian method. Compared to the Levey–Jennings control chart, the novel control chart presents an alert earlier when a deviation occurs and shows a fake alert later when there is no deviation.

Conclusion

The parallel tests showed that the longer the time is, the better the test’s proficiency. We concluded that the empirical Bayesian method could be applied effectively to improve the capability of daily control in CBC laboratory tests.

Keywords:

• empirical Bayesian
• EB
• average run length
• ARL
• complete blood count
• CBC
• Levey–Jennings control chart

Acknowledgments

This research was funded by Ten Chan General Hospital (TCGH) and Ministry of Science and Technology (MOST) for supporting this research with ID TCGH 1060306001; MOST 105-2662-E-161-002-CC3; MOST 108-2221-E-161-003-MY2 and this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors are grateful for all medical technologists of the laboratory of Ten-Chen Medical Group, Ten Chan General Hospital (Chung Li) for their support and help in this study. Chen-Mao Liao and Chih-Ming Lin are co-first authors for this study.

Patient Consent for Publication

Not required.

Ethics Approval and Consent to Participate

Not required. There are no patient laboratory data in this study.

Consent for Publication

This manuscript contains no person’s details, images, or videos.

Disclosure

The authors report no conflicts of interest for this work.