Contribution of EQA to improve Preanalytical practices by systematic verification of Laboratory Services

International literature describes the preanalytical phase as the most susceptible to errors due to the numerous non automated activities it involves Most EQA organizers offer preanalytical schemes to participants. There are basically three types of surveys procedures registration, samples circulation and errors registration The Portuguese EQA Programme ( provides these type of schemes for 13 years, using as a guide the ISO 15189 2012 In order to improve the evaluation of the preanalytical phase, PNAEQ recently launched two other preanalytical EQA schemes, mystery client and presential audits in 2015 and 2016 respectively. The aim of the mystery client survey is to verify whether the information provided to the patient is constant regardless the day and time or if it is dependent on the collaborator. The aim of the presential audit survey is to give the participants a tool to verify if the procedures performed daily are in accordance with laboratorial good practices recommendations. Conclusions: Results from Mystery Client surveys demonstrate the need for written procedures and harmonization of practices for all collaborators, as more than a third of the responses differed in date/time and operator in a global view. In the Presential Audit surveys we highlight as critical points the results regarding questions 3 5 and 6 as they point to specific problems that occurred during the blood collection procedure, such as operator and patient safety, as well as the quality of the sample collected, suggesting the need to review legal and normative issues and to train collaborators. Participants who use systematically these two methodologies are monitoring some of the requirements of ISO 15189:2012, namely 4. 1.2.6, 4.3, 4.4.1, 4.14, 5.4.2 (both), 5.4.4.2 (mystery client) and 5.1.2, 5.2.2, 5.2.5, 5.3.2.5, 5.3.2.7, 5.4.4 (presential audit), contributing to release reliable results for medical decisions. For the future, we will extend the questions and items in evaluation in these two surveys to Microbiology area and continuing to offer training in Preanalytical matters.N/

PNAEQ - 13 years of post-analytical EQAS in Portugal

In the last 13 years, PNAEQ provided a specific program on post-analytical phase. In order to raise the offer of schemes in areas like Thrombosis/ Haemostasis, PNAEQ has established a consortium with ECAT Foundation distributing two more schemes: Post- Analytical Platelet Function and Pre- and Post-Analytical in Haemostasis. Furthermore, five of the analytical schemes organized by PNAEQ include a post-analytical interpretation, such as Blood Morphology, Hemoglobinopathies, Hydatidose, Rubella and Toxoplasmosis. The main objective of implementing specific and integrated programs on post-analytical phase is to evaluate the performance of laboratories on these matters in order to improve their quality service. The specific program on post-analytical phase provided by PNAEQ comprises 6 types of surveys: audits (vertical and presential), case simulation, case-study, document evaluation, quality indicators and questionnaires. Each survey represents a different tool to evaluate several items of the post-analytical process (Table 1), as well as the laboratory collaborators involved in each task (Figure 1). The items in evaluation are annually selected in the PNAEQ Working Group on Pre- and Post-Analytical Phase (created in 2015) and in compliance with the Portuguese Legislation and the ISO 15189:2012(E). Since 2007 PNAEQ has distributed 6 types of tools in the Post-Analytical Phase EQA, stabilizing in 3 of them in the last five years: Audits, Case Simulation and Quality Indicators. The participation rate has been increasing since 2015, which can be due to the multiple actions performed by PNAEQ Working Group on Pre- and Post-Analytical Phase. In addition, the Case Simulation surveys are the most participated (74% average) since the participation depends on PNAEQ. For the future, PNAEQ and the Working Group will work on the continuous update of the tools content distributed in each survey according to international references and the experience of other EQA organizers.N/

Evaluation of the Sigma Quality level for Serum Iron determination by two colorimetric methods, Ferrozine and Ferene S

Iron plays important functions in the body such as the formation and functioning of hemoglobin and it’s disorders are among the most common diseases of human1. It is essential to ensure that its levels determination through laboratory tests are accurate and precise. The participation of laboratories in the External Quality Assessment (EQA) allows the increases of the quality level of the laboratory results and improvement of its performance.2This study was developed in the Portuguese Nacional EQA Program (PNAEQ) concerning the laboratories results from the Clinical Chemistry Scheme. The main objective of this study was to evaluate and improve the sigma quality level regarding the Iron parameter and reduce the variability of the laboratories results participating in the EQA program of Clinical Chemistry of the Nacional External Quality Assessment Program (PNAEQ). The mean Sigma quality level indicated that the Ferrozine method had a better performance compared with Ferene S method. Half of the control samples had a sigma quality level higher than 3.0, which is set as the minimum acceptable quality.3 Despite of the improved of the Sigma quality level in the Pilot Test, the results demonstrated a need to improved the analytical process performance and to identified more potential causes and implement new improvement actions. It becomes necessary to raise awareness with the laboratories, improving the Pilot Test participation frequency, resulting in a recurrent and current assessment of the laboratory activity performance. Developing Six Sigma projects on a periodic basis is important for continuously and progressively increasing the level of Sigma quality in laboratory examinations. The main advantage of quality assessment on the sigma scale is providing evidence of overall laboratory performance, taking into account random and systematic errors.N/

How can the EQA provider encourage the participation in Pre-Analytical schemes

Providing a quality sample and ensuring the best laboratory practices should be the aim of Pre-Analytical Phase. With analytical phase strictly controlled, pre-analytical phase should be the laboratories target for improvement processes. Concerning to this, it is important to have in place a proper system for error detection for this extra-analytical phase and to be able to detect errors that have a significant negative effect on sample quality and patient health. Although laboratory managers are becoming to concern about these issues, the participation rate on the national program on pre-analytical phase is still very low, which means that the EQA provider should have an intervention more active than it has with the analytical phase. In order to contradict this weak participation and to reach the laboratories needs, PNAEQ (Programa Nacional de Avaliação Externa da Qualidade) has launched two types of schemes in which laboratories participation depends mainly of the EQA provider. One is the “mystery client”, which simulates a real life scenario to verify if the information provided to the patient depends on the laboratory collaborator. The other one is a presential audit, which identify some of the real errors occurred during the blood drawing. The aim of these two types of surveys is to demonstrate that most of the pre-analytical errors are detectable and, more important than that, they can be corrected or eliminated when pre-analytical phase is controlled.N/

10 anos de Avaliação Externa da Qualidade da Fase Pré-Analítica em Portugal

A implementação de um programa específico de AEQ na fase pré-analítica permite avaliar o desempenho dos laboratórios à semelhança do que é feito na fase analítica. Nos últimos 10 anos, o Programa Nacional de Avaliação Externa da Qualidade (PNAEQ) disponibilizou diferentes ensaios que incluíram distribuição de questionários, envio de amostras e simulação de casos, e promoveu reuniões e ações de formação com os participantes.N/

Integração da Avaliação da Fase Pré-Analítica na rotina laboratorial

Com a fase analítica estritamente controlada, o objetivo dos laboratórios deverá voltar-se para a qualidade das amostras analisadas e para a segurança dos procedimentos na fase pré-analítica. Para tal, o laboratório deverá integrar procedimentos de controlo de qualidade interno e de avaliação externa da qualidade na rotina laboratorial, implementando ferramentas adequadas para a deteção, monitorização e redução/eliminação de erros cujo efeito tenha um impacto negativo significativo na qualidade da amostra com repercussão nos resultados laboratoriais e na saúde do técnico e do utente. O Programa Nacional de Avaliação Externa da Qualidade (PNAEQ) disponibiliza várias ferramentas aos laboratórios inscritos no programa de Avaliação da Fase Pré-Analítica que, quando utilizados de forma contínua na rotina laboratorial, permitem ao laboratório realizar o controlo de qualidade interno da fase pré-analítica.N/

Determinants of research-based spin-offs survival

Existing literature has shown that research-based spin-offs firms usually exhibit lower death risks than other start-ups. However, few studies have focused on the survival determinants of these particular firms. From a unique self-collected database of the population of research-based spin-offs created in Portugal from 1995 up to 2007 we analyze if founding conditions, parent organization characteristics and location characteristics play a role on their survival. Our results show that start-up size, firm age, parent reputation and region characteristics are key determinants of research-based spin-offs survival, casting doubts on the role played by the incubation process and the social ties with the parent organization as advanced in previous studies.COMPETE; QREN; FEDER; Fundação para a Ciência e a Tecnologia (FCT

Does venture capital really foster innovation?

Using panel data of 17 European Union countries, we find robust empirical support for a positive impact of venture capital on innovation. After controlling for the potential endogenous relationship between venture capital and innovation, the results indicate that venture capital fosters innovation but mainly on a later stage.CEMPRE; QREN; FEDER; Fundação para a Ciência e a Tecnologia (FCT

The effect of entrepreneurial origin on firms' performance: the case of Portuguese academic spinoffs

We investigate the role of entrepreneurial origin on firms' performance by comparing academic spinoff firms with their non-academic counterparts. Academic spinoffs grow through resources accumulation and internationalization; yet they do not translate these advantages into productivity gains. The access to upstream complementary resources appears to play a chief role in explaining the academic spinoffs' superior performance. Academic spinoffs are contributing to economic development by creating new jobs, but their relevance as a source of sustained economic value is limited so far.This work was carried out within the funding with COMPETE reference POCI-01-0145-FEDER-006683 (UID/ECO/03182/2013), with the FCT/MEC's (Fundacao para a Ciencia e Tecnologia) financial support through national funding and by the ERDF through the operational program on "Competitiveness and Internalization-COMPETE 2020 under the PT2020 Partnership Agreement.

External Quality Assessment in Laboratory Safety Area (PNAEQ-1S Segurança Laboratorial)

Introduction: The National External Quality Assessment Program (PNAEQ) provides tools for carrying out external quality assessment in Laboratory Safety area, since 2010. These tools have changed over the years, but all of them allow the identification of occurrences and/or critical points in the operation, installations or equipment, that could have impact on the safety of patients and workers, beyond prioritize the necessary improvement actions. Aims: Presentation of data and methodology implemented in PNAEQ since 2010, for the External Quality Assessment (EQA) in Laboratory Safety area.info:eu-repo/semantics/publishedVersio