1998年彰化地區院際血液品管調查結果之分析

An External Hematology Quality-Control Survey in Chang-Hua Area in 1998

1998年由彰化區域醫療網所主辦之臨床血液外部品質保證計劃，調查項目包括一般血液計數，血液抹片中的白血球分類以及血液細胞圖片鑑識。本次調查以自願參加此計畫之醫學檢驗機構為對象，調查過程可分為3個階段。於一般血液計數及白血球分類調查中，第1階段各有65/79家（82.3%）以及54/70家（77.1%）醫學檢驗機構所得結果屬於合格範圍內。而針對第1階段不合格之檢驗機構所做之第2階段複測，結果各有7／14家（50.0%）及6/16家（37.5%）醫學檢驗機構通過複測，而對於那些二次調查結果均不合格之單位（一般血液計數：7/79，白血球分類：10/70），則須接受品管小組針對其缺失所做之輔導以及輔導結束後之複測。在所有參加的醫學檢驗機構中，若以醫院等級來區分，則以準醫學中心以及區域醫院之合格率最佳，其次分別為地區教學醫院、私人檢驗所、地區醫院以及衛生所等。在圖片鑑識方面，對於圖片1、2、3以及4鑑識結果之合格率分別為78.7%，90.7%，88.0%，and 93.3%。由以上的結果顯示，強調調查與輔導並重之寶驗室間的品質管制計劃，的確有助於提昇臨床血液學的檢驗品質。

In 1998, an external quality assurance (EQA) program was undertaken by Chang-Hua Area Medical Network to examine the differences in many hematological parameters including the complete blood count (CBC), the microscopic examination on differential leucocyte count (DC) of the blood smear, and the recognition of blood cells on photographs. This investigation of CBC and DC was divided into three stages. In the first stage examination, 82.3% (65/79) and 77.1% (54/70) of the voluntary participants satisfied the CBC and DC standards, respectively. The re-examined institutions unqualified for the first survey passed for CBC and DC to be 8.9% (7/79) and 8.6% (6/70), respectively. Finally, those institutions (CBC:7/79; DC10/70), which didn't pass from first and second survey, had to accept the guidance for the defects and a later re-testing. Among these medical laboratories, is would-be medical center and regional Hospital had the highest qualifying rate of CBC and DC, followed by district teaching hospitals, privacy medical laboratories, district hospitals, and health centers. 78.7%, 90.7%, 88.0%, and 93.3% of the results in the blood photograph discrimination were located in the acceptable range for the photograph 1, 2, 3, and 4, respectively. These results revealed that the inter-laboratory quality control program emphasizing investigation and guidance was contributed to elevating the hematological testing quality.