External Quality Assurance (EQA) Procedures

1. Exchange of slides scheme.
2. Proficiency testing schemes.
3. Accreditation and certification of cytotechnologists and cytopathologists.
4. Appraisal of Management , laboratory organisation and performance.

EQA : Exchange of slides & proficiency testing

• Exchange of slides: Inter-laboratory exchange of slides is useful in increasing diagnostic consistency and standardisation of reporting. They  also have a useful educational function.
• Proficiency testing schemes: This scheme(or a modification of it) is in use in the USA and UK. Papanicolaou stained cervical smears selected specifically for assessment purpose are taken by a facilitator to each cytology laboratory participating in the scheme. All members of staff  (cytotechnologists and cytopathologists) who undertake cervical screening are given a set of 10 slides to screen and report  within  two hours. The facilitator marks the test and informs each participant  of his/her results.  The scheme detects unacceptable levels of performance. Confidentiality is an essential component of the scheme.

EQA :Accreditation and certification

• Accreditation This is a process by which a committee of experts appointed by an independent agency evaluates and certifies whether an institute or laboratory satisfies predetermined standards which have been previously agreed by the group. Accredited organisations provide reassurance to their users. ISO 9000 is a pan European accreditation scheme but a few countries (e.g.  UK) have their own.
• Certification The  skill and experience of a cytotechnologist has an important impact on the quality of the reports issued by the laboratory. The European Federation of Cytology Societies (EFCS)QUATE Aptitude test for cervical cytology is an international test  which is designed to provide an objective assessment of a cytotechnologists competence to screen cervical smears. It can be taken by cytotechnologists who have passed their national or regional  examination (if there is one)  or who have had a minimum of two years experience (5000 smears per annum) of cervical screening. 

Summary of quality assurance procedures:

Internal QAP (daily basis)	Internal QAP (monthly basis)
Check data entry, stains, laboratory processing	Biopsy/cytology comparison
Systematic assessment of smear adequacy	Review smear history of women with CIN3 or invasive cancer for possible false negative smears
QC check of negative and inadequate smears	Statistical monitoring of laboratory performance
Referral of abnormal smears and cases with suspicious clinical features to pathologist	Control workload, regulate slide storage, Monitor turnaround time
Peer review of abnormal smears	Check standard operating procedures (SOPs) are up to date