[Quality improvement project 'laboratory diagnosis by family physicians' leads to considerable decrease in number of laboratory tests]. / Kwaliteitsverbeteringsproject 'laboratoriumdiagnostiek door huisartsen' leidt tot aanzienlijke reductie van het aantal laboratoriumanalysen.

OBJECTIVE: Quality improvement of laboratory diagnostics by general practitioners (GPs) through introduction of a simplified, problem-oriented application form, supported by information and feedback. DESIGN: Prospective descriptive study. SETTING: Laboratory of Clinical Chemistry and Haematology of St. Maartens Gasthuis, Venlo, the Netherlands and the GPs in the region. METHODS: The effects of the intervention were measured by counting the analyses requested by all GPs in the region in 1992, 1993 and 1994. Furthermore requests by every GP for fifteen selected analyses in the first 6 months of 1992, 1993 and 1994 were counted and reported together with the anonymous data of all colleagues. RESULTS: After the intervention a 23% reduction of the total number of analyses request by GPs was noticed. Blood sampling increased by 8% and the mean number of laboratory test requests per patient decreased from 5.9 to 4.2. The largest request reductions were noticed for analyses not listed on the application form. Measurements in the first 6 months of 1992, 1993 and 1994 showed continuation of the trend and a fadeaway of 'redundant' analyses. CONCLUSION: The introduction of a simplified problem-oriented application form for GPs supported by feedback caused a marked decrease of the number of (redundant) laboratory requests.

A programme for post-graduate training and quality control in blood cell morphology.

The programme presented can be considered as a combination of permanent education with quality control carried out on a regional level. The selection procedure of blood smears for distribution will be discussed. The sensitivity and specificity are tested of many frequently occurring haematological abnormalities.

Fresh human blood as the source of a regional quality survey programme in haematology.

In a regional quality survey programme in haematology with a limited number of participants (15 in the region described), it appeared possible to use unpreserved, fresh, EDTA-anticoagulated blood samples. With such samples only the results from hospital laboratories with different instruments and methods could adequately be compared. From the results of single analyses obtained in ten different samples, the systematic differences as well as the precision of the analyses were calculated for each hospital laboratory with respect to haemoglobin, packed cell volume, red blood cell count, white blood cell count, and platelet count.