Annual audit of haematology tests performed at a laboratory of a tertiary teaching hospital in Dar es salaam Tanzania

  • William Frank Mawalla Muhimbili University of Health and Allied Sciences
  • Rahma Ally Muhimbili National Hospital
  • Ivan Nyamahanga Muhimbili National Hospital
  • Eunice Shija Muhimbili National Hospital
  • Michael Mtaki Muhimbili University of Health and Allied Sciences
  • Yohana Mtali Muhimbili University of Health and Allied Sciences
  • Josephine Mgaya Muhimbili University of Health and Allied Sciences
  • Heavenlight Christopher Muhimbili University of Health and Allied Sciences
  • Clara Chamba Muhimbili University of Health and Allied Sciences
  • Furahini Tluway Muhimbili University of Health and Allied Sciences
  • Julie Makani Muhimbili University of Health and Allied Sciences

Abstract

Background

Monitoring of laboratory performance is crucial as it plays a central role in diagnosis, management and clinical decision making. With commencement of haematology clinical and laboratory services at the MUHAS Academic Medical Centre (MAMC); smooth ordering, handling and transfer of specimen and timely return of results can be challenging. We aimed to assess the function and efficacy of haematology clinics and evaluate the capacity of MAMC laboratory in performing tests ordered from the haematology clinics, as established by hospital guidelines.

Methodology

This was a retrospective descriptive study conducted from 1st of January to 31st March, 2018 in MAMC in Dar es Salaam, Tanzania. The study involved the Haematology and Blood Transfusion outpatient clinic department and laboratory section. Analytical and post-analytical phases of laboratory functions were measured against established standards stipulated under MAMC specialized clinic and laboratory services guidelines.

Results

A total of 53 patients attended the weekly haematology clinics. None had Haemoglobin (Hb) or Complete Blood Count (CBC) results available before doctor’s consultation. 75 different haematological tests were ordered. 81.3% of orders were collected and only 21.3% of the collected have results available in the Hospital Information System (HIS). Sickle Cell Disease (SCD) tests are not performed at MAMC. Half of the hemoglobin results (Hb) and two-third of the complete blood count results (CBC) were under the Turnaround Time (TAT) from time of sample collection to results, respectively. The number is lower when taken from the time of test order.

Conclusion

The weekly haematology clinics at MAMC operate below the standards set by the hospital. This is significantly contributed by laboratory performance. The capacity and operation of the MAMC laboratory is still below set standards, both in terms of number of haematological tests it performs and attainment of set TAT. Reporting of results to the HIS is also not fully implemented.

Keywords: Audit, Haematology, Sickle Cell Disease, Turnaround Time, Hospital Information System, Outpatient Department, Clinics, Haemoglobin, Complete Blood Count

Author Biography

William Frank Mawalla, Muhimbili University of Health and Allied Sciences
Haematology and Blood Transfusion

References

Scrivener R, Morrell C, Baker R, Redsell S, Shaw E, Stevenson K, Pink D, Bromwich N. Principles for best practice in clinical audit. International Journal for Quality in Health Care. 2002;15:87–97.

Erasmus RT, Zemlin AE. Clinical audit in the laboratory. Journal of Clinical Pathology. 2009;62:593–597.

Quality Institute. Making the laboratory a key partner in patient safety. Proceedings of the Quality Institute Conference; 13–15 April 2003, Atlanta (GA).

Plebani M. The importance of laboratory reasoning. Clin Chim Acta 1999;280:35–45.

Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med 2006;44:750–759

Makubi AN, Meda C, Magesa A, Minja P, Mlalasi J, Salum Z, et al. Audit of clinical-laboratory practices in haematology and blood transfusion at Muhimbili National Hospital in Tanzania. Tanzan J Health Res. 2012;14(4):257–262.

Trenti T, Canali C, Scognamiglio A. Clinical governance and evidence-based laboratory medicine. Clin Chem Lab Med 2006;44:724–32.

National Institute for Clinical Excellence. Principles for best practice in clinical audit. London: National Institute for Clinical Excellence, 2002.

Johnston G, Crombie IK, Davies HT, et al. Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care 2000;9:23–36.

Published
2019-09-24
Section
Original Research