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BACKGROUND: Quality indicators are tools used to monitor specific activities within a process and improve it. In the area of clinical laboratories, the National Accreditation Standards for Providers of Health and the ISO 15189 standard recommend the implementation of indicators that monitor the test cycle with emphasis on those that contribute to a safer health care. AIM: To describe the implementation of nine indicators in a hospital clinical laboratory and their measurement during one year. MATERIAL AND METHODS: The indicators implemented and measured were four of the pre-analytical phase (number of rejected samples, times of transport, blood culture contamination and blood cultures inoculated with adequate blood volumes), two of the analytical phase (coherence of Gram stains of blood culture with microorganism cultured and correct results in external quality control surveys) and three of the post-analytical phase (compliance with order to report lapse goals, corrected reports and alert values report). RESULTS: Two indicators of pre-analytical phase did not meet the per determined targets: number of rejected samples and blood cultures inoculated with adequate blood volume. All indicators of the analytical and post analytical phases were within the pre-determined targets. CONCLUSIONS: Coordinated work should be initiated especially with the nursing service to correct the two indicators that did not meet the target. The incorporation of quality indicators to monitor critical processes within the laboratory was undoubtedly an opportunity to identify areas for improvement.

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Background: Quality indicators are tools used to monitor specific activities within a process and improve it. In the area of clinical laboratories, the National Accreditation Standards for Providers of Health and the ISO 15189 standard recommend the implementation of indicators that monitor the test cycle with emphasis on those that contribute to a safer health care. Aim: To describe the implementation of nine indicators in a hospital clinical laboratory and their measurement during one year. Material and Methods: The indicators implemented and measured were four of the pre-analytical phase (number of rejected samples, times of transport, blood culture contamination and blood cultures inoculated with adequate blood volumes), two of the analytical phase (coherence of Gram stains of blood culture with microorganism cultured and correct results in external quality control surveys) and three of the post-analytical phase (compliance with order to report lapse goals, corrected reports and alert values report). Results: Two indicators of pre-analytical phase did not meet the per determined targets: number of rejected samples and blood cultures inoculated with adequate blood volume. All indicators of the analytical and post analytical phases were within thepre-determined targets. Conclusions: Coordinated work should be initiated especially with the nursing service to correct the two indicators that did not meet the target. The incorporation of quality indicators to monitor critical processes within the laboratory was undoubtedly an opportunity to identify areas for improvement.

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Among the many biomarkers studied to evaluate myocardial damage, troponin is considered the most sensitive and specific. However, current methodologies present pre-analytical, analytical and post-analytical problems, of which the more significant are the lack of standardization and a high uncertainty in the level of decision or cut-off. It is hoped that a new generation of assays called "ultra sensitive" will improve analytical performance characteristics of the technique and achieve compliance with the internationally recommended quality specifications.

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Among the many biomarkers studied to evaluate myocardial damage, troponin is considered the most sensitive and specific. However, current methodologies present pre-analytical, analytical and post-analytical problems, of which the more significant are the lack of standardization and a high uncertainty in the level of decision or cut-off. It is hoped that a new generation of assays called "ultra sensitive" will improve analytical performance characteristics of the technique and achieve compliance with the internationally recommended quality specifications.

Entre los múltiples biomarcadores estudiados para evaluar daño miocárdico, la troponina se considera el más sensible y específico. Sin embargo, la mayoría de las metodologías actuales utilizadas para su determinación presentan problemas tanto pre-analíticos, analíticos como post-analíticos, de los cuales los más relevantes son la falta de estandarización y una imprecisión alta en el nivel de decisión o de corte. Se espera que una nueva generación de ensayos para la determinación de troponina, denominados ultrasensibles, mejoren las características de desempeño de la técnica y logren cumplir con las especificaciones de calidad recomendadas internacionalmente.

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BACKGROUND: An alert value is a result suggesting that the patient is at imminent danger unless appropriate remedial actions begin promptly. Report of alert values (AV) by the clinical laboratories has taken special relevance in recent years due to its contribution to patient's care. AIM: To report results of AV informed during 2007 within the Health Network of the Pontificia Universidad Católica de Chile. MATERIAL AND METHODS: Analysis of AV recorded in a centralized database of the laboratories of the health network, between January and December, 2007. RESULTS: Total number of AV was 5.366, which represented 0.3% of total examinations and corresponded mainly to the clinical chemistry area. Potassium levels generated the higher number of AV detected, followed by positive blood cultures. Eighty two percent of AV corresponded to hospitalized patients. The greater number of AV was reported to intermediate and intensive care services. Thirty two percent of AV was informed to the physician or professional in charge of the patient within 5 minutes of obtaining the results and 79% within 30 minutes. CONCLUSIONS: To obtain a real impact on patient management, it is fundamental to shorten the lapse between the obtainment of tests results and the warning, supported on appropriate computerized systems, and to spread the procedure to all personnel involved in patient's care.

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Examinations performed beside the bed of patients ("Point-of-care testing, POCT") provide immediate results and are simple to perform. The most common of these tests is the self control of blood glucose levels in diabetic patients. The use of these devices at the hospital level, introduces a new set of requirements to health institutions, which should monitor all aspects of the process, including training of final users, proper quality control, development of written procedures for use and even participation in surveys of external quality control, avoiding the generation of errors and guaranteeing patient safety.

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Background: An alert value is a result suggesting that the patient is at imminent danger unless appropriate remedial actions begin promptly. Report of alert values (AV) by the clinical laboratories has taken special relevance in recent years due to its contribution to patient's care. Aim: To report results of AV informed during 2007 within the Health Network of the Pontificia Universidad Católica de Chile. Material and methods: Analysis of AV recorded in a centralized database of the laboratories of the health network, between January and December, 2007. Results: Total number of AV was 5.366, which represented 0.3 percent of total examinations and corresponded mainly to the clinical chemistry area. Potassium levels generated the higher number of AV detected, followed by positive blood cultures. Eighty two percent of AV corresponded to hospitalized patients. The greater number of AV was reported to intermediate and intensive care services. Thirty two percent of AV was informed to the physician or professional in charge of the patient within 5 minutes of obtaining the results and 79 percent within 30 minutes. Conclusions: To obtain a real impact on patient management, it is fundamental to shorten the ¡apse between the obtainment of tests results and the warning, supported on appropriate computerized systems, and to spread the procedure to all personnel involved in patient's care (RevMéd Chile 2009; 137: 1137-44).

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Examinations performed beside the bed of patients ("Point-ofcare testing, POCT") provide immediate results and are simple to perform. The most common of these tests is the self control of blood glucose levels in diabetic patients. The use of these devices at the hospital level, introduces a new set of requirements to health institutions, which should monitor all aspects of the process, including training of final users, proper quality control, development of written procedures for use and even participation in surveys of external quality control, avoiding the generation of errors and guaranting patient safety (Rev Méd Chile 2009; 137:1261-4).

Los exámenes realizados al lado de la cama del enfermo ("Point of care testing, POCT") tienen como mayor ventaja la rapidez en la entrega de resultados y la simplicidad de uso, siendo su principal aplicación el autocontrol de la glicemia en pacientes diabéticos. El uso de estos equipos a nivel hospitalario introduce exigencias a las instituciones de salud, las cuales deben monitorizar todos ¡os aspectos del proceso, incluyendo la capacitación de los usuarios, el adecuado control de calidad, el desarrollo de procedimientos escritos para su uso e inclusive la participación en encuestas de control de calidad externo, evitando la generación de errores y colaborando así con la seguridad del paciente.

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The Chilean Autonomous Commission for Medical Specialties Certification recognized Clinical Laboratory as a specialty in 1994. This decision was based on the great development of the specialty that incorporated new methodologies and developed automatic computerized methods. The main objective of the Clinical Laboratory specialist is to work as a consultant to define the laboratory diagnostic strategies that have the best cost effectiveness ratio. He must also select and assess diagnostic methods, supervise their implementations and assure the quality of the results generated. He must also be an efficient laboratory director and administrator.

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UNLABELLED: Congenital syphilis (CS) is an important health problem in Chile, with a rate of 0.25/1,000 live newborn (NB) during year 2004. In 2000, the Chilean Ministry of Public Health recommended to perform a screening in cord blood at the moment of delivery. Instead, the Centers for Disease Control and Prevention guidelines recommend the screening in maternal serum since cord blood has up to 5% of false (-) versus 0.5% of maternal serum, both with respect to the NB serum. OBJECTIVE: Maternal serum and NB cord blood were studied during one year to determine the best screening method at delivery. METHODS: RPR was performed and positive results were confirmed by treponemic test (immunochromatographyDetermine, ELISA Captia, Ig and IgM, and MHA-Tp). Serologically confirmed patients were evaluated by the specialist to define CS cases. RESULTS: Between June 1999 and August 2000 2,741 binomies were studied; of these, 37 (1.3%) were RPR reactive and 2.704 were non-reactive. In 11 of the 37 reactive cases, mother and NB were RPR reactive (Group I), in 9 cases the NB was RPR reactive and the mother was non-reactive (Group II), and the other 17 were NB non-reactive and mother reactive (Group III). In group I, 7/11 (64%) were true (+)s and 4/11(36%)) false (+)s of RPR. In group II, 9/9 (100%) corresponded to false (+)s of RPR in cord blood, and in group III, 11/17 (65%) corresponded to false (+)s of RPR in maternal blood but 6/17 (35%) were found to be cases of syphilis during pregnancy. Three of them were not treated opportunely and were designed as CS. In total 9 NB corresponded to CS (6 in group I and 3 in group III). If the screening had been performed only in cord blood, three NB with CS would have not been diagnosed. CONCLUSION: Even when maternal serum has a high rate of false (+)s, it has better sensitivity than cord blood for the diagnosis of CS, thus it is suggested to perform the screening at delivery with maternal serum instead of cord blood samples.

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