title: Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots.
abstract: BACKGROUND
  The aim of this paper is to present results of first two years of preanalytical external quality assessment (EQA) in Croatia.
  
  
  METHODS
  This paper summarizes results from 6 rounds of preanalytical EQA during 2014-2016 in 161-175 Croatian laboratories (number ranged between cycles). EQA was designed as an online survey of the compliance with National recommendations for phlebotomy (NRP). Forty-seven questions in 5 categories are analyzed (materials and equipment, patient identification, patient preparation, sampling and storage). Additionally, preanalytical cases are presented. Overall performance scores (Question score (Qscore) for compliance with NRP and Case score (Cscore) for preanalytical cases) are calculated for each question/case as a proportion of laboratories with satisfactory procedure (x 100). Qscores and Cscores ≥ 70 were classified as acceptable (maximal score = 100).
  
  
  RESULTS
  In investigation of compliance with NRP, acceptable Qscores were obtained for 34/47 questions. The lowest scores were observed for the availability of sterile disposable tourniquets (Qscore = 15) and safe-sharp needles (Qscore = 34), obtaining patients address as an identifier (Qscore = 21), using glycolysis inhibitor tubes for glucose concentration measurement (Qscore = 21) and verification of manufacturers declarations on temperature and time of storage (Qscore = 31). There was no statistically significant difference in overall Qscore according to different categories of phlebotomy procedures (P = 0.284). The results of preanalytical cases showed acceptable Cscore values for all cases (89-96).
  
  
  CONCLUSIONS
  First two years of preanalytical EQA showed good compliance with the NRP and excellent expertise in resolving complex preanalytical issues. Major critical spots are lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes.
authors.affiliation: University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia; Working group for preanalytical phase, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.
authors.forename: Nora
authors.initials: N
authors.lastname: Nikolac
authors.affiliation: Department of laboratory diagnostics, Children's hospital Zagreb, Croatia; CROQALM, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.
authors.forename: Jasna Lenicek
authors.initials: JL
authors.lastname: Krleza
authors.affiliation: Working group for preanalytical phase, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Simundic
mesh_terms: D001671:Biochemistry / Q000592:standards*; D001800:Blood Specimen Collection / Q000592:standards*; D019411:Clinical Laboratory Techniques / Q000592:standards*; D017523:Croatia; D006801:Humans; D013677:Medical Laboratory Science / Q000592:standards*; D018962:Phlebotomy / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care; D011786:Quality Control; D013048:Specimen Handling / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: external quality assessment; laboratory error; preanalytical phase