Reasons for Proficiency Testing Failures in
Routine Chemistry Analysis in China
Tingting Li, MSc,1,2** Haijian Zhao, MSc,1** Cuanbao Zhang, MSc,1 Wei Wang, BA,1
Falin He, MSc,1 Kun Zhong, MSc,1 Shuai Yuan, PhD,1 Zhiguo Wang, MSc1,2*
Laboratory Medicine 50:1:103-110
DOI: 10.1093/labmed/lmy032
ABSTRACT
Objective: To understand the reasons for proficiency testing (PT)
failures, toward the goal of continuous improvement of laboratory
services.
Methods: Laboratories participating in PT of routine chemistry
testing provided by the National Center for Clinical Laboratories
(NCCL) of China were given 3 schemes for handling PT failures in
2016. If they had unsatisfactory PT performance, they were notified
and requested to investigate failure errors and submit data regarding
those errors.
Results: Failure types were distributed as follows, per error group:
Clerical, 10.2%; Methodological, 16.2%; Equipment, 23.6%; Technical,
The scope of proficiency testing (PT) in the clinical labora-
tory has evolved considerably since Belk and Sunderman
provided the first PT program in the late 1940s.1 However,
the first PT program in China was not provided until 1982
by the National Center for Clinical Laboratories (NCCL) of
China. Today, the PT program has become an essential
component of the quality management system in laborato-
ries; it is required by laboratory accreditation organizations
in many countries, including China.2,3 Unlike the Clinical
Abbreviations
PT, proficiency testing; NCCL, National Center for Clinical Laboratories;
CLIA, Clinical Laboratory Improvement Amendments; CAP, College of
American Pathologists; EQA, External Quality Assessment; CLSI, Clinical &
Laboratory Standards Institute; SDI, standard deviation index; QC, quality
control.
1
National Center for Clinical Laboratories/Beijing Engineering Research
Center of Laboratory Medicine, Beijing Hospital, National Center of
Gerontology, Beijing, China; 2Graduate School, Peking Union Medical
College, Chinese Academy of Medical Sciences, Beijing, China
*To whom correspondence should be addressed.
zgwang@nccl.org.cn
**
Joint first author: contributed equally to this work.
© American Society for Clinical Pathology 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
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37.4%; PT Evaluation, 0.5%; Unexplained, 11.5%; and Other, 0.7%.
Reasons unique to the PT process accounted for 15.6% of all reasons.
Corrective actions mainly included correcting calibration, maintaining
or changing equipment, strengthening reagent management, rewriting
procedures, and retraining staff members.
Conclusions: The causes for PT failures relate mainly to laboratory
problems, not to the PT process itself. Therefore, PT sponsored by the
NCCL is an effective evaluation tool for laboratory performance. Also,
laboratories should strive to improve analytical performance.
Keywords: proficiency testing, clinical chemistry test, PT error, quality
assurance, performance evaluation, corrective action
Laboratory Improvement Amendments (CLIA) of 19884 in
the United States, the PT program was voluntary in China.
Because laboratory test reports are released from pro-
cesses that meet their quality specifications, an evaluation
that reveals unacceptable results by a PT provider yields
an unexpected outcome for the laboratory. In response, the
laboratory should investigate the causes of error and correct
the procedure that led to PT failures, to reduce or eliminate
the chances of recurrences. Outcomes of investigations
into the reasons of PT failures can be used by laboratories,
by manufacturers, and by the PT providers themselves in
improving their respective products and service.5–8
The results of a survey by Klee and Forsman6 of the Mayo
Clinic during 1985 and 1986 showed that only 28% of PT
failures were associated with analytic errors, 23% were unex-
plained, and the rest were related to the difference between
processes in the PT program and in the handling of patient
specimens. In contrast, the College of American Pathologists
(CAP) Q-Probes study6 of 665 laboratories and the study
by Hoeltge and Duckworth indicated that PT is a good indi-
cator of the technical ability of the laboratory to perform a
test.7,8 To determine the value of using PT results in judging
103
Management & Administration
laboratory performance, it should be demonstrated that the
causes of PT failures relate mainly to laboratory-operation
problems other than the PT process itself. Therefore, we
initiated an investigation into the reasons for PT failures, to
determine whether PT sponsored by the NCCL of China is an
effective evaluation tool for laboratory performance.
Materials and Methods
Study Design
A large number (n = 2369) of laboratories distributed in dif-
ferent provinces in China voluntarily participated in the 2016
routine chemistry PT program. An estimated 30.4% of labo-
ratories participated in voluntary PT organized by the NCCL.
Participating laboratories came from hospitals with different
categories (general hospital, 56.2%; specialist hospital, 11.1%;
maternal and child care service centers, 10.0%; Traditional
Chinese Medicine hospitals, 10.7%; hospitals of Traditional
Chinese and Western medicine, 6.2%; and other, 5.8%) and
different scales. The numbers of beds that hospitals offered
were as follows: 0 to 500, 50.1%; 501 to 1000, 20.1%; 1001
to 1500, 10.5%; 1501 to 2000, 10.8%; and greater than 2000,
8.5%. To a certain extent, the results from these hospitals rep-
resented the entire performance of laboratories in China.
In the routine chemistry PT program organized by the
NCCL, 5 specimens were provided for each of 3 testing
events every year. The concentrations within the 5 lots of
specimens encompass the reportable range that was typical
of most analytical systems. PT specimens were provided
through mailed shipments in February 2016, along with PT
instructions that detailed how to reconstitute, store, and
prepare PT specimens. Laboratories were notified once PT
specimens were sent out, and they could find the tracking
number at the Clinet website (http://www.clinet.com.cn/).
After PT specimens were received, the laboratories were
to examine them and determine whether there were prob-
lems that might affect the measurement or results report-
ing (eg, damaged packaging, double labeling, confusing
identification, misplaced). When specimens were missing
or damaged, a laboratory could notify the NCCL to obtain
replacements. Laboratories were to examine PT speci-
mens in the same way as they examine patient specimens
and to submit the results via the Clinet External Quality
Assessment (EQA) reporting system, version 1.5 (developed
104  Lab Medicine 2019;50;103–110
DOI: 10.1093/labmed/lmy032
by the NCCL), before the deadline. If the results for a spe-
cific analyte were not submitted in a timely manner by a
laboratory, that laboratory would obtain a score of 0 for
the analyte in this testing event. Two weeks after the dead-
line for results reporting, participants received a report that
included an evaluation of whether their performance met
the acceptable criteria of specific analytes from the NCCL.
Participants who received unsatisfactory PT performance
score(s) for 1 or more analytes in each testing event of
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2016 were notified and required to submit the corre-
sponding information on PT results via the EQA reporting
system within 24 hours of receiving PT reports. The dead-
line for reporting the information was November 30, 2016.
Information requested included the description of the rea-
son for failure for each unacceptable PT result and the cor-
responding corrective actions. In the beginning of 2016, we
provided laboratories with 3 schemes for handling PT fail-
ures; laboratories could investigate the causes of PT failures
referring to any of these 3 schemes. When reporting rea-
sons for unacceptable results, laboratories were to describe
the reasons and corrective actions in detail. Researchers
working on the study would carefully read the information
submitted and classify reasons mainly based on Clinical &
Laboratory Standards Institute (CLSI) document QMS24.5
If there were queries regarding the submitted information,
we would call the reporting personnel for verification. At the
same time, combining categorization for problems in CLSI
document QMS 24 and the failure types that laboratories
reported in the investigation, we could modify, add, or
delete some reasons and form the modified reason classi-
fication that was suited for more laboratories. At the end of
the study and after summarizing reasons for PT failures in
other clinical-chemistry analyses, we could provide the PT
Exception Investigation Worksheet for Clinical Chemistry
Analysis (Supplementry Appendix 1) to the laboratory, which
applied to most quantitative clinical-chemistry analytes (the
reasons for PT failures in other clinical chemistry analyses
have not been published).
Definition of Challenge and Event
Challenge―for quantitative tests, an assessment of the
amount of substance or analyte present or measured in
a specimen
PT event―a single round of proficiency testing, which
included 5 challenges in routine chemistry analysis
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Target Value
The target value of routine chemistry in the PT program was
determined as a peer-group method mean. We estimated
this value according to robust analysis of algorithm A, as
described in ISO 13528: 2015.9
Evaluation Criteria
For this study, we used equation 1 to determine the analyte
testing event score. Analyte Score for the Testing Event
Number of acceptable for the analyte
= ´100 (1)
Total number of challenges forr the analyte
Failure to attain a score of 80 for each analyte in each test-
ing event constituted unsatisfactory analyte performance for
the testing event. Failure to attain a score of 80 for an ana-
lyte in 2 consecutive or 2 of 3 consecutive testing events
constituted unsuccessful PT performance.
Standard Deviation Index Range
We used equation 2 to determine the standard deviation
index (SDI):
SDI =
PT result of your laboratory - Target value
(2)
Standard deviation
where the target value was determined as the robust mean
of the peer group and the SD refers to the robust SD of the
peer group; both values were calculated by robust analysis
via Clinet EQA statistical analysis software, version 5.5.0.46
(developed by the NCCL). For example, if a laboratory
reported a serum sodium concentration of 140 mmol per L,
the target value for the peer group was 130 mmol per L, and
the peer group SD was 2.7 mmol per L, and then the SDI was
determined as ([130 mmol/L―140 mmol/L]/ 2.7 mmol/L) = 3.7.
Classifying PT Failures
Table 1 shows the final version of classification for routine
chemistry in the study. In the Table, classes of possible
causes of unacceptable results included 7 major groups.
Clerical problems were related to errors in the process when
reporting PT results. Methodological problems were related to
the analytical test system or the documented procedure itself.
Equipment problems were related to analytical instruments or
pieces of equipment used as part of the method. Technical
problems were related to personnel and the operation of
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Management & Administration
equipment or performance of the method. Problems with PT
Evaluation had non-subgroups. The Unexplained category
referred to those problems for which, after investigation,
no specific cause was revealed. The last major group was
Other, which was used for problems that could not be cate-
gorized within the previous groups. The difference between
Unexplained and Other was that the reasons for the former
were unknown, but those for latter were clear and could not
be categorized within any of the aforementioned groups.
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Statistical Analysis
Data received were analyzed using the SPSS Statistical
Package for the Social Sciences (IBM SPSS Statistics for
Windows, version 20.0, IBM Corporation) and MS Excel 2007
(Microsoft Corporation). The Kruskal-Wallis H test was used to
determine whether the SDI in different reason categories was
different; P <.05 was considered to be statistically significant.
We used Mann-Whitney U tests to run pairwise comparisons
after the H test and used the Bonferroni method for correcting
the H test ad hoc analysis. A corrected value of P <.002 was
considered to be statistically significant for results of U testing.
Results
The 2369 laboratories evaluated 762,120 challenges that
occurred during 152,424 PT events. Of the 152,424 PT
events, 4838 were evaluated as showing unsatisfactory PT
performance for a specific analyte in the entire year. Of these,
1186 were evaluated as showing unsuccessful PT perfor-
mance for an analyte (882 of which failed 2 testing events
[302 failed successively and 580 discontinuously], 304 of
which failed 3 successive testing events); the rest (3652) only
failed 1 testing event for a specific analyte. Overall, 1907 par-
ticipating laboratories (80.5%) had at least 1 unacceptable
PT result (ie, failed at least 1 challenge in a testing event). Of
these, 474 (24.9%) had no unsatisfactory analyte performance
in every testing event; the remaining laboratories may have
had unsatisfactory PT performance for 1 or more analyte.
In this investigation, participants submitted information,
including reasons and corrective actions taken, for 7883
unacceptable challenge results (60.0% of all unaccept-
able results) in 2568 unsatisfactory PT events (53.1% of
all unsatisfactory PT events). As for problematic submitted
information (15.0% of all responding results), 85.2% was
verified by telephone, and the reasons were all corrected.
Lab Medicine 2019;50;103–110   105
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Management & Administration

Table 1. Categories of Causes of Unacceptable Proficiency Testing Results in the NCCL-Sponsored

Routine Chemistry PT Programs
Category Subgroup Unacceptable Result, no. % of All Reasons
Clerical Total 802 10.2
Result transcription errora,b 466 5.9
Incorrect units reportedb 99 1.3
Incorrect instrument or method reported on the formb 95 1.2
Results submitted not related to correct analyteb 77 1.0
Not submittedb 65 0.8
Methodological Total 1277 16.2

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Problem in manufacturing of reagents or reference materialsa 587 7.4
Incorrect assignment of calibrator valuea 165 2.1
Staff not adequately trained or proven competent to perform procedures 132 1.7
Biased method, or method lacks sensitivity and/or specificity 64 0.8
Imprecision due to variation between reagent lots 62 0.8
Inadequate QC method 62 0.8
Environmental change (eg, source of water and decoration) 53 0.7
Unstable calibration 49 0.6
Carryover from previous specimen(s) 37 0.5
Regent, calibrators, or control materials from different manufacturers 16 0.2
Result affected by factors related to PT specimens 28 0.4
Problem with procedure or inappropriate reference intervals 22 0.3
Equipment Total 1859 23.6
Failure to adhere to scheduled instrument maintenance proceduresa 1535 19.5
Equipment malfunctiona 272 3.5
Obstruction of instrument tubing or orifice by clog or protein 31 0.4
Dysfunctional instrument settings specified by manufacturer 21 0.3
Technical Total 2949 37.4
Calibration problems (eg, expired calibration curve and calibrator) a 1368 17.4
Management problems for reagent (eg, contamination of reagent)a 786 10.0
Improper reconstitution, preparation, or storage of PT specimensa–c 229 2.9
Improper preparation or storage of reference materials or reagent 111 1.4
Failure to test correct PT specimensb,c 106 1.3
Failure to act on QC results that indicate a method problem 90 1.1
Mixed use of reagent with different lot numbers 86 1.1
Delay in testing after reconstitution of PT specimensb,c 52 0.7
Pipetting or dilution errorc 38 0.5
Failure to follow written procedures or recommended instrument 55 0.7
function checks
Calculation error 19 0.2
Contamination of PT specimen during processingc 9 0.1
PT Evaluation Inappropriate peer groupb 41 0.5
Unexplained a Total 903 11.5
Other Total 52 0.7
NCCL. National Center for Clinical Laboratories; PT, proficiency testing; QC: quality control.
a
One of the main reasons for discordant PT findings (80.0% of all reasons).
b
Deemed by the authors to be unique to the PT process (15.6% of all reasons for unsatisfactory PT events).
c
Deemed by authors to potentially have multiple analyte failure within a PT event.

Comprehensive Analysis of Reasons for PT
Failure
In Table 1, we show the categories of causes of unaccept-
able PT results. A total of 9 subgroups accounted for 80.0%
of the reasons for PT failures, with the problem of “Failure
to adhere to scheduled instrument maintenance proce-
dures” being the most common reason. According to the
consensus by several experts of the NCCL in China, 9 sub-
groups were deemed as being unique to the PT process,
accounting for 15.6% of all reasons, and 5 subgroups were
deemed to potentially contribute to multiple analyte failure
within a PT event.
Laboratories reporting “Failure to test correct PT speci-
mens” as a reason for failure indicated that they failed 9

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DOI: 10.1093/labmed/lmy032

Figure 1
Box plot of the Standard Deviation Index (SDI) for the major groups of reasons for proficiency testing (PT) failure.
to 20 analytes. Almost all laboratories (88.9%) reporting
“Improper reconstitution, preparation, or storage of PT
specimens” indicated that they failed 6 or fewer analytes,
and 11.1% reported failing between 10 and 25 analytes.
None of the participants reporting “Delay in testing after
reconstitution of PT specimens” or “Pipetting or dilution
error” indicated failing more than 3 analytes. All labora-
tories reporting “Contamination of PT specimen during
processing” failed 3 analytes in a testing event.
Analysis of PT Failure Type by SDI
A box plot of the SDI over the different major reason
groups is shown in Figure 1. The results of H testing
showed that the SDI in different categories differed signifi-
cantly (P <.001). Multiple comparison (U test) showed that
the differences in the groups between Methodological and
Equipment (P = .006), Technical (P = .03), Unexplained
(P = .13), Other (P = .009), Equipment and Technical
(P = .01), Unexplained (P = .008), Other (P = .01),
Technical and Unexplained (P = .02), Other (P = .01), and
Unexplained and Other (P = .007) were all nonsignificant.
The SDIs for the Clerical and PT Evaluation groups were
significantly greater than other groups (all P <.001).
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Corrective Action
Some participants (31.4%) corrected the problems in cali-
bration, including increasing calibration frequency, changing
calibration method, or calibrator. A total of 27.2% of partic-
ipants took actions to improve problems with instruments
or equipment used as part of the method—for example,
replacing old equipment. Also, 17.9% removed the prob-
lems with reagents, which involved obtaining suggestions
from reagent vendors or even changing reagent manufac-
turers. In addition, some participants (6.6%) strengthened
management in works related to the PT process, including
multiple checks when submitting PT results and staff train-
ing on the PT process. As a result, a fraction of laboratories
(10.4%) that could not explain the unacceptable results
after investigation did not take any corrective actions.
Discussion
This study characterized how 2369 participating laborato-
ries performed on 762,120 challenges in routine chemistry
provided by the NCCL during 2016. The results are unique
Lab Medicine 2019;50;103–110   107
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Management & Administration
Table 2. Distribution of Reasons for Proficiency Testing Failure in 3 Studies
Variable NCCL Study, 2016
Laboratories, No.
All PT challenges, No.
Failed PT challenges, no.
Analytes Routine Chemistry
Technical (%)
Equipment (%)
Methodological (%)
Unexplained (%)
Clerical (%)
PT evaluation (%)
Other (%)
PT, proficiency testing.
a
The data in the Zhao et al study were analyzed by PT events; there were 5 challenges in a PT event.
to the situation of routine chemistry analytes, and the cat-
egorizations are limited to use in evaluation of quantitative
measurement.
Our findings indicated that repeated failures of PT events
within a laboratory were very rare. Most of those failures
occurred in the next testing event or with 1 pass between
2 events. Only a fraction of those events failed 3 PT events
in a row. That is, unsuccessful PT performances for specific
analytes were few; this result was similar to those from
other studies.7,11
Classifying the problem of PT failures was the most impor-
tant part of the study. Two previous studies from China
and CAP investigated the reasons for early PT failures.
Details about these 2 studies and the present one are
shown in Table 2. The percentages in the Unexplained cat-
egory during 2013 and 2016 in NCCL were smaller than
that those percentages in the CAP study. The change in
the Unexplained category percentages may suggest that
participants have more knowledge of the PT process and
are better able to recognize errors of unacceptable results.
The main analytical related reasons for PT failures in these
studies were different. Blood gas analytes were included
in the CAP Study, whereas in the others, they were not, so
analyte-specific errors may exist. Comparing the results
of the present study with those from the study by Zhao
et al,10 we found that the percentages of problems in the
Methodological category became smaller and may indicate
that laboratories themselves or manufacturers have made
some improvements in their methodology for routine chem-
istry analysis, such as using more-accurate methods or
changing manufacturers of reagents or reference materials.
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DOI: 10.1093/labmed/lmy032
Zhao et al, 201311 CAP Q-Probes Study, 19926
2369 1779 665
762,120 38,826 PT eventsa 616,467
7883 699 PT eventsa 7792
Routine Chemistry Clinical Chemistry and Blood Gas Analysis
37.4 6.5 18.80
23.6 28.5 14.20b
16.2 45.1 18.40
11.5 11.7 24.10
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10.2 6.5 11.90
0.5 0 6.80
0.7 0 5.90
Of the 9 most-common problems for PT failures, which
accounted for 80.0% of all the reasons, only 2, namely, “Result
transcription error” and “Improper reconstitution, preparation,
or storage of PT specimens”, were unique to the PT process.
The small percentages (total: 7.8%) of the 2 reasons suggest
that most problems identified from unacceptable results would
also affect measurement of patient specimens. That is, labo-
ratories were able to detect that analytical problems exist in
laboratory operation and quality management.
The 3 main reasons for unacceptable PT results—“Failure to
adhere to scheduled instrument maintenance procedures”
(19.5%), “Calibration problems” (17.4%), and “Management
problems for reagent” (10.0%)—can all be corrected funda-
mentally. As in other studies,7,10 we found that many unac-
ceptable results were unexplained. Because statistically
based PT grading systems determine PT failures based
on the distribution of PT results, statistical failures can be
regarded as a result of random error when detected by this
grading system and may explain why some unexplained
discordance exists. However, proper laboratory records
may help laboratories determine the reason(s) for unaccept-
able PT performance, so the reports of some participants
that their PT failures were unexplained may result from an
inability to reconstruct what happened when analyzing the
PT specimens.
Reasons unique to the PT process (Table 1) comprise 15.6%
of all failures; this percentage was smaller than that in the CAP
Study (which accounted for 24.5%).7 In contrast, most reasons
(72.2%) were related to laboratory analytical performance,
which demonstrated that PT, the most extensive external
quality-control tool used by an accreditation organization, is a
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potential tool to monitor performance improvement over time
and to assess overall laboratory analytical performance. This
finding is similar to that stated by many reports.12–14 Moreover,
it is suggested that laboratories have more knowledge of PT
and can be familiar with the PT process with time. Reporting
reasons for PT failures and corrective actions taken not only
can help laboratories detect PT failures and pay more attention
to PT process but also can help the PT provider find problems
unique to the PT process—for example, improving the web-
based submitting system.
The errors attributable to several subgroups that we com-
piled represent failure modes that should impact more than
1 analyte or even, perhaps, the entire PT event. For these
reasons, we studied the number of analytes with failing
results within a PT event and found that most laboratories
failed more than 6 analytes and some laboratories even
reported failing all analytes within an event. Therefore, the
laboratory can consider these reasons when there are PT
failures for several analytes within a test event. However,
laboratories reporting “Delay in testing after reconstitu-
tion of PT specimens”, “Pipetting or dilution error”, or
“Contamination of PT specimen during processing” only
failed 2 or 3 analytes. The lack of multiple analyte failure
within an event could be due to less impact on some ana-
lytes or wider acceptable ranges for analytes not failed.
We were not surprised that none of the participants reported
PT Material problems and few reported PT Evaluation prob-
lems. As for PT Material problems, such as inappropriate
stability or homogeneity, PT specimens that were mislabe-
led, and PT specimen material that had deteriorated in tran-
sit, these errors are the responsibility of the PT provider and
are often impossible for participants to detect. As for the PT
Evaluation problems, participants having little knowledge of
what is required to interpret PT results (including the process
of target value assignment and acceptable criteria) may con-
tribute to unquestioning acceptance of all results from PT
reports.15–18 So, PT providers should comment on specific
data-handling processes in the feedback report.
As Figure 1 shows, the SDI in the Clerical and PT Evaluation
groups were greater than those in the other groups; the results
of Kruskal-Wallis testing also demonstrate this result. Thus,
when the SDI of the unacceptable result was greater than 10,
the priority of investigation of reasons should be given to these
2 groups. Yet, the differences among other major categories
were not significant. When the SDI of the unacceptable result
was lower than 5, the SDI may not provide help. An SDI in
the range of 2 to 3 implies a developing problem that could
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Management & Administration
contribute to a true PT failure but is also in a region susceptible
to statistical noise that could indicate false problems.
Now that we have elaborated the reasons for PT failures, how
can laboratory scientists use this information to help the lab-
oratory investigate PT failures? It is best that laboratories take
limited steps to investigate obvious clerical problems first and
then take more comprehensive steps to find hidden errors in
analytical processes, including those in the Methodological,
Equipment, and Technical categories. Perhaps laboratories
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can use the relationship between major groups and the SDI
as the basis for determining the most major group. Then, one
can use Table 1 to identify subgroups in which the ratios were
statistically created and consider the most common reason
at the beginning. In some conditions, the laboratory may
need the PT Exception Investigation Worksheet for Clinical
Chemistry Analysis (Supplementary Appendix 1) to detect
problems comprehensively and thoroughly. Also, immediate
records of each step of the PT process may assist laboratory
scientists in finding technical problems. Finally, if one sus-
pects that the problems are generated by the PT provider, it
is incumbent on the laboratory to inform the PT provider and
request suggestions. At the same time, the participating lab-
oratories can analyze freely the tendencies of cumulative PT
results at http://www.clinet.com.cn/; Liu et al19 report specific
examples of the use of this website.
Despite its promising findings, our investigation has certain
limitations. First, because participants are distributed in dif-
ferent Chinese provinces, it was impossible to perform field
investigations of the reasons, and the information gathered
could only be submitted via the online reporting system.
Second, because each laboratory voluntarily participated in
the PT program and there are no punitive measures for the
laboratories with unsatisfactory PT performance, it is only
required that the laboratory report failing reasons before a
set time, rather than within a specific ranges of dates after
receiving the PT report. Finally, high percentages of unex-
plained unsatisfactory performance may limit the use of PT
results as the unique indicator of laboratory ability to meas-
ure routine chemistry analytes accurately.
As a critical evaluation tool for laboratory performance,
PT instructed us to routinely monitor laboratory analytic
performance and take corrective actions when the causes
for PT failures had been found to assure the accuracy of
measurement of patient specimens. In this study, it was
shown that the reasons for PT failures relate mainly to
laboratory operation problems rather than the PT process
itself. Therefore, PT, sponsored by the NCCL of China, is an
Lab Medicine 2019;50;103–110   109
DOI: 10.1093/labmed/lmy032
Management & Administration
effective evaluation tool for laboratory performance. This tool
may also prove effective in laboratory systems in other parts
of the world. LM
Funding
Funding for this study was provided by the Beijing Natural
Science Foundation (grant/award no. 7143182); and Beijing
Hospital Foundation (grant/award number: BJ-2015–025).
Acknowledgments
We thank the laboratories and institutions that participated
in this survey. We also thank the staff members of the Clinet
website (http://www.clinet.com.cn), who provided the com-
puter-technology support to establish the network platform
for the survey and relevant services.
Supplementary Data
Supplemental figures and tables can be found in the online
version of this article at www.labmedicine.com
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