A review of the quality of gastrointestinal investigations performed in UK laboratories

Abstract

Background: About 10 years ago, a survey showed significant deficiencies in the quality of gastrointestinal investigations performed by UK laboratories. Subsequently, several clinical guidelines have been developed and external quality assessment schemes introduced. This survey was performed to assess whether earlier deficiencies have been addressed. Methods: The repertoire of gastrointestinal investigations in UK departments of clinical biochemistry was obtained by questionnaire. Nominees were sent further questionnaires to assess various aspects of the service. Analytical performance was determined by sending samples for analysis and by reviewing external quality assessment (EQA) programmes. Results: The survey showed that in many instances no internal quality control (IQC) is used, analytical performance is poor, reference ranges are inaccurate, protocols are inappropriate, EQA is not adopted, some useful tests are not widely available and interpretation for some tests is inadequate. Conclusions: Much of the responsibility for this scenario lies with individual laboratories. Although participation in available EQA schemes is mandatory for accreditation, many laboratories are failing to participate in such schemes, and IQC is inadequate for many gastrointestinal tests. One reason for the poor performance is likely to be the low numbers of tests performed: laboratories receiving infrequent requests may be less able to produce reliable results and develop interpretive expertise. The survey highlights areas requiring the development of consensus guidelines by the Association for Clinical Biochemistry and British Society of Gastroenterology, so that appropriate tests are available and a reliable analytical service provided for laboratory-based and point-of-care gastrointestinal investigations in the UK.