title: Assessing Clinical Laboratory Quality: A College of American Pathologists Q-Probes Study of Prothrombin Time INR Structures, Processes, and Outcomes in 98 Laboratories.
abstract: BACKGROUND
  The anticoagulant warfarin has been identified as the second most frequent drug responsible for serious, disabling, and fatal adverse drug events in the United States, and its effect on blood coagulation is monitored by the laboratory test called international normalized ratio (INR).
  
  
  OBJECTIVE
  To determine the presence of INR policies and procedures, INR practices, and completeness and timeliness of reporting critical INR results in participants' clinical laboratories.
  
  
  METHODS
  Participants reviewed their INR policies and procedure requirements, identified their practices by using a questionnaire, and studied completeness of documentation and timeliness of reporting critical value INR results for outpatients and emergency department patients.
  
  
  RESULTS
  In 98 participating institutions, the 5 required policies and procedures were in place in 93% to 99% of clinical laboratories. Fifteen options for the allowable variations among duplicate results from different analyzers, 12 different timeliness goals for reporting critical values, and 18 unique critical value limits were used by participants. All required documentation elements were present in 94.8% of 192 reviewed INR validation reports. Critical value INR results were reported within the time frame established by the laboratory for 93.4% of 2604 results, but 1.0% of results were not reported. Although the median laboratories successfully communicated all critical results within their established time frames and had all the required validation elements based in their 2 most recent INR calculations, those participants at the lowest 10th percentile were successful in 80.0% and 85.7% of these requirements, respectively.
  
  
  CONCLUSIONS
  Significant opportunities exist for adherence to INR procedural requirements and for practice patterns and timeliness goals for INR critical results' reporting.
authors: Peter J
authors: PJ
authors: Howanitz
authors: Theresa P
authors: TP
authors: Darcy
authors: Frederick A
authors: FA
authors: Meier
authors: From the Department of Pathology, State University of New York, Downstate Medical Center, Brooklyn (Dr Howanitz); the Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, (Dr Darcy); the Department of Pathology, Henry Ford Health System, Detroit, Michigan (Dr Meier), and the Surveys Department, College of American Pathologists, Northfield, Illinois (Ms. Bashleben).
authors: Christine P
authors: CP
authors: Bashleben
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects; D064790:Clinical Laboratory Services / Q000592:standards; D006801:Humans; D019934:International Normalized Ratio / Q000592:standards*; D007753:Laboratories / Q000592:standards*; D059021:Laboratory Proficiency Testing / Q000592:standards; D010338:Pathology, Clinical / Q000592:standards; D011517:Prothrombin Time / Q000592:standards*; D011786:Quality Control; D012015:Reference Standards; D012955:Societies, Medical; D014481:United States; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin