Often, whenever there is a case of a wrong diagnosis, there is the tendency to quickly pass the blame to the doctor. On numerous occasions, I have encountered cases where the doctor has been wrongly accused by a patient. I have also seen cases where a patient comes to hospital when his/her condition has deteriorated and a review of their previous treatment reveals missed opportunities for better health outcomes due to wrong, or incomplete diagnosis in the laboratory, or imaging results.
‘Your doctor is as good as the diagnostic test results’ has been one of my mottos in my experience in the health sector. What this means is that even the best of medical specialists will make an incorrect assessment of the patient’s condition if presented with the wrong diagnostic test results.
A doctor uses the results presented to him/her to make the correct diagnosis and to develop a treatment plan for the patient. Sometimes, a healthcare professional will ask for a repeat of the tests if there are glaring inconsistencies or when the treatment plan presents gaps, but this is not always the case, and, therefore, accuracy of results is of utmost importance.
So one may ask, what makes a good diagnostic centre?
Right technology and personnel
Correct diagnosis requires the right equipment to eliminate the risk of errors and help improve health outcomes. Use of advanced technologies helps to process tests correctly, efficiently and precisely. We must, therefore, ensure that diagnostic centres have state-of-the art equipment for the tests required.
Secondly, even with the right equipment, poorly trained or unqualified personnel will interpret tests wrongly, or write wrong reports. Therefore, it is extremely important that we have qualified professionals carrying out tests in the fields they are qualified in. In addition, regular upgrade of knowledge and skills will keep staff up-to-date with the latest developments in their field.
A relevant analogy can be air travel. You need modern aeroplanes and qualified pilots to ensure safe air travel. If you do not take a risk when flying why would you take a risk with your health!
Quality control is another important aspect of ensuring correct diagnostics. It ensures both precision and accuracy of patient sample results. Regular calibration of laboratory equipment is a critical aspect of quality control. Calibration involves comparing a reading on one piece of equipment or system, with another piece of equipment that has been calibrated and referenced to a known set of parameters. The equipment used as a reference should itself be directly traceable to the equipment that is calibrated. To be confident in the results being measured, there is an ongoing need to perform calibration every shift and maintain the calibration of the equipment throughout its lifetime for reliable, accurate and repeatable measurements.
Another aspect of quality control is accreditation by an independent third party. Accreditation is a voluntary program in which trained external peer reviewers evaluate a healthcare organization’s compliance and compare it with pre-established performance standards. Research has shown that accreditation improves the quality of care provided by various healthcare systems.
Laboratory accreditation is a widely accepted process of evaluating quality, performance, reliability and efficiency. Accreditation from one or more international quality control bodies ensures that a diagnostic centre’s processes are benchmarked on internationally accepted standards and processes. The laboratory also benefits from global new knowledge that helps improves healthcare outcomes.
The list of international accreditation bodies includes the College of American Pathologists (CAP), Joint Commission International (JCI), South African National Accreditation System(SANAS), International Standardisation Organisation (ISO), the United Kingdom Accreditation Services (UKAS), the Clinical Pathology Accreditation (CPA) and the National Association of Testing Authorities (NATA).
The accreditation process is a rigorous exercise and an investment that takes time, resources and sometimes the re-engineering of your processes to ensure compliance with established standards. This process is dynamic and the requirements continually change as new knowledge and standards are adopted globally.
At Aga Khan University Hospital, our laboratory is accredited by College of American Pathology (CAP) and South African National Accreditation System(SANAS). This requires us to adhere to pre-established standards relating to laboratory records, quality control of procedures for the preceding accreditation period, qualifications of laboratory staff, equipment, facilities, set safety programs and their recording, and overall laboratory management. We renew this accreditation every two years.
We also calibrate our equipment within the timelines given under the manufacturer’s instructions. Meeting all these requirements take a lot of time, money, resources and expertise but we are obligated to do it to ensure the accuracy of our tests, a key element of our quality health outcomes for our patients.
Accurate diagnosis is the first step towards treating a medical condition. An error in diagnosis can lead to administration of wrong medication while an incomplete diagnosis can delay the treatment of the condition which, in some cases, can be fatal. So take time to consider these factors as you identify a diagnostics centre for your next test, your life can literally depend on it.
In summary Aga Khan University has the following accreditations: ISO, SANAS, JCI and CAP. The reason for all of them is because we care for our patients and want them to receive the best care possible. We care from our heart!
By Dr Shawn Bolouki, Chief Executive Officer at Aga Khan University Hospital, Nairobi