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Why You Shouldn’t Skimp on Quality Control​

Don’t be over-reliant on technology that you forget to perform adequate quality control.

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Originally published in the September 2014 issue of Veterinary Practice News

Advances in diagnostic equipment for veterinarians continue to be made. There’s a lot to be positive about, but a number of experts point to concerns about practitioners being over-reliant on technology and not performing adequate quality control.

Manufacturers of diagnostic equipment years ago started out with hematology and chemistry units that were a bit awkward, but over time they have become easier to use, more efficient and can offer more results, noted Brent Hoff, DVM, DVSc, Dipl. Tox.

The makers of the new equipment have been “a little too good to the veterinarians,” he said, in that there’s now a pervasive notion that veterinarians can just run these machines without a great deal of forethought and training, said Dr. Hoff, a clinical pathologist and clinical toxicologist at the Animal Health Laboratory at the University of Guelph in Ontario, Canada.

“The companies haven’t been [consistently] good at pointing out that these point-of-care pieces of equipment really need some quality assurance and quality control for there to be valuable results,” Hoff said.

Linda M. Vap, DVM, Dipl. ACVP, also worries about quality control.

“I am concerned about the number of places that use rather technical equipment without doing sufficient QC or understanding how to interpret QC data,” said Vap, an assistant professor of microbiology, immunology and pathology at Colorado State University College of Veterinary Medicine and Biomedical Sciences.

“This is particularly true for hematology analyzers whose marketing staff suggest there is no need for a manual differential because their instrument performs an automated one.”

Dr. Vap is one of the authors of a 2013 report from the American Society for Veterinary Clinical Pathology titled “Quality Assurance for Point-of-Care Testing in Veterinary Medicine.”

Because there is no governmental regulation in point-of-care testing, veterinarians must demonstrate a commitment to quality assurance and quality control, according to the guidelines.

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“Concern about the quality of veterinary in–clinic testing has been expressed by veterinarians themselves in published literature; however, little, if any, concise and practical guidance is available to veterinary practitioners on this topic,” the guidelines state.

“Veterinary guidelines and textbooks are aimed at laboratory professionals and complex laboratory equipment such as found in reference laboratories. In the authors’ experience, laboratory QA/QC instruction in veterinary curricula is scant, leaving new graduates with little training in how to establish, evaluate and maintain the quality of in-clinic laboratory testing.”

Another author of those guidelines, Bente Flatland, DVM, Dipl. ACVP, Dipl. ACVIM, offered her take on point-of-care instruments and test kits marketed to veterinarians.

“In my experience, many veterinarians provide laboratory services through some combination of in-clinic and reference laboratory testing,” said Dr. Flatland, an associate professor of clinical pathology at the Department of Biomedical and Diagnostic Sciences College of Veterinary Medicine at the University of Tennessee.

“Practitioners should decide which approach is most cost-effective for them.”

Flatland pointed to the guidelines as a good source for veterinarians considering point-of-care testing. She noted that the guidelines provide considerations for implementing in-clinic testing and instrument selection, as well as laboratory instruments require care and maintenance. 

“Clearly, the ability to analyze fresh samples, rapid turn-around time for results, and potential revenue stream are advantages of providing in-clinic testing,” she said. 

“In-clinic testing also requires a financial and time commitment to quality assurance, including appropriate physical space, appropriately trained operators, appropriate instrument maintenance, appropriate handling and disposal of biological materials, and a dedicated budget for supplies and training/continuing education.”

Advancements

Nancy Soares, VMD, vice president of the American Animal Hospital Association Board of Directors, is excited about several advancements in diagnostics in the veterinary field in the last year or two.

Dr. Soares, who is also the owner and medical director of Macungie Animal Hospital in Macungie, Pa., sees many of these advancements as a boon to veterinary practitioners mobile technology among them.

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VetConnect Plus, for example, is a new mobile app that is free on the iTunes store that provides diagnostic software that enables users the ability to view, trend, interpret and share diagnostic information anytime, anywhere and from any device –iPhone, iPad, home computer.

Whether a practice runs the tests in-house or at an outside reference laboratory, all of a patient’s diagnostic history is in one location in cloud-based storage and can’t get misplaced, Soares noted.

“This new product allows veterinarians to make more informed healthcare decisions for the best possible care for their patients and share results easily with referring veterinarians, specialists and even with client-friendly reports to increase compliance or support and gain agreement on recommendations,” Soares said.

Another recent diagnostic breakthrough Soares likes is an in-house hematology analyzer designed to produce an accurate and comprehensive hemogram in only 90 seconds. The analyzer has been around a few years, but in 2013 the Band Neutrophil and Nucleated Red Blood Cell diagnostic information was added. 

“In addition, it has the capability to run abdominal and thoracic fluids,” Soares added.

Hoff is concerned about lack of quality control—or veterinarians’ failure to follow through on maintenance as required.

“Veterinarians tend to forget about the basics of hematology and chemistry,” he cautioned, adding that most of time the machines operate just fine, but “The big thing we’re missing in the veterinary practice is point-of-care and quality assurance and quality control.” 

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