title: External quality assessment of medical laboratories in Croatia: preliminary evaluation of post-analytical laboratory testing.
abstract: BACKGROUND
  Proper standardization of laboratory testing requires assessment of performance after the tests are performed, known as the post-analytical phase. A nationwide external quality assessment (EQA) scheme implemented in Croatia in 2014 includes a questionnaire on post-analytical practices, and the present study examined laboratory responses in order to identify current post-analytical phase practices and identify areas for improvement.
  
  
  METHODS
  In four EQA exercises between September 2014 and December 2015, 145-174 medical laboratories across Croatia were surveyed using the Module 11 questionnaire on the post-analytical phase of testing. Based on their responses, the laboratories were evaluated on four quality indicators: turnaround time (TAT), critical values, interpretative comments and procedures in the event of abnormal results. Results were presented as absolute numbers and percentages.
  
  
  RESULTS
  Just over half of laboratories (56.3%) monitored TAT. Laboratories varied substantially in how they dealt with critical values. Most laboratories (65-97%) issued interpretative comments with test results. One third of medical laboratories (30.6-33.3%) issued abnormal test results without confirming them in additional testing.
  
  
  CONCLUSIONS
  Our results suggest that the nationwide post-analytical EQA scheme launched in 2014 in Croatia has yet to be implemented to the full. To close the gaps between existing recommendations and laboratory practice, laboratory professionals should focus on ensuring that TAT is monitored and lists of critical values are established within laboratories. Professional bodies/institutions should focus on clarify and harmonized rules to standardized practices and applied for adding interpretative comments to laboratory test results and for dealing with abnormal test results.
authors.affiliation: 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.
authors.forename: Jasna Lenicek
authors.initials: JL
authors.lastname: Krleza
authors.affiliation: Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.
authors.forename: Adrijana
authors.initials: A
authors.lastname: Dorotic
authors.affiliation: 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.
authors.forename: Ana
authors.initials: A
authors.lastname: Grzunov
mesh_terms: D019411:Clinical Laboratory Techniques / Q000592:standards*; D017523:Croatia; D003951:Diagnostic Errors / Q000517:prevention & control*; D006801:Humans; D059021:Laboratory Proficiency Testing / Q000592:standards*; D008137:Longitudinal Studies; D013677:Medical Laboratory Science / Q000592:standards*; D010338:Pathology, Clinical / Q000592:standards*; D011785:Quality Assurance, Health Care; D011786:Quality Control; D012189:Retrospective Studies
keywords: external quality assessment; post-analytical phase; questionnaire; standardization