Reducing Repeat Testing Of Liver and Pancreatic Enzymes in Clinical Biochemistry Laboratory by Root Cause Analysis

Objectives : To reduce the number of repeat tests of Aspartate aminotransferase, Alanine aminotransferase, Alkaline phosphatase, Amylase and Lipase in clinical biochemistry laboratory by finding the root cause Methodology: After obtaining approval from institutional ethics committee, 4 months data (August2020 to November2020) on repeat testing (redos) was analysed for the following non-critical parameters--Aspartate aminotransferase, Alanine aminotransferase, Alkaline phosphatase, Amylase, Lipase. Laboratory policy was amended to perform repeat testing only upon clinician request for these parameters and same 6 months data (December 2020 to May 2021) was re analysed after policy amendment. Results: Average redos/1000 tests for 4 months were found to be 6.497 out of which the percentage contribution of serum enzymes was found to be 19.43% (AST-5.21%, ALT-5.18%, ALP-1.19%, Amylase 1.02%, Lipase-6.83%) costing the laboratory INR 22245/-. Root cause analysis showed that these enzymes were repeated in dilution when the result was greater than analytical measurement range without request from clinician. Corrective action was to stop repeat testing of samples in dilution only on request form clinician. Data after corrective action showed average redos/1000 tests for 6-months to be 4.404 out of which the percentage contribution of serum enzymes was found to be 7.32% (AST-3.08%, ALT-2.75%, ALP-0.73%, Amylase 0.14%, Lipase-0.61%) costing the laboratory INR 6901/-. Conclusion: Repeat testing of non-critical parameters only on clinician request can reduce burden on laboratory and improve Quality. Keywords : Repeat testing, Quality indicators, Laboratory management, Liver Enzymes, Pancreatic Enzymes