Tools, Technologies and Training for Healthcare Laboratories

Top Ten Findings of the Global QC Survey

There's a wealth of data and findings in the Global QC Survey of 2021. But we extracted the top ten most interesting ones here.

 The Top Ten Findings of the 2021 Global QC Survey Results

Sten Westgard, MS
November 2021

 2021 QC sruvey world map QC practices

[This survey was completed with the support and partnership of Technopath Clinical Diagnostics.]


When we conducted the 2021 Global QC Survey, we broke down all of the findings by country and regions. So we can compare how the different areas of the world practice QC. In this highlight, we rank the following regions: USA (all by itself), Europe (with Canada and Australia thrown in), Latin and South America, the Middle-East, and Asia.

1. Who uses 2 SD control limits the most?

 The US has the highest rate of using 2 SD control limits, 73% using them on all tests, 90% using them on some or all of their tests. In contrast, Latin and South America has the lowest rate of using 2 SD, with 48% reporting the use of them on all tests, 73% on some or all of their tests, and 26% reporting that they don't allow them on any of their tests. Well done!

2. Who uses "Westgard Rules" the most?

78% of the Middle-East respondents use "Westgard Rules" on all their tests, and 93% use the multirule on some or all of their tests. And 0% of labs in the region report using no "Westgard Rules" at all. On the other end of the scale, US laboratories in our survey make the least use of the rules: "only" 58% of labs use them on all their tests, 76% use them on some or all of them, and a global high of 16% of labs don't use "Westgard Rules" at all. Is, as they say, a case of familiarity breeding contempt? We often take for granted the things that are closest to us.

3. Who uses Manufacturer Ranges for Control Charts the most?

The guidelines, the regulations, the experts all agree: you should set your own mean and SD and build your control limits from them. However, Europe is the worst offender: nearly two-thirds of European laboratories (64%) in our survey use the ranges provided to them by manufacturers. Latin and South America win the best rating - only 46% of their resposnes state they use those ranges

4. Who uses the most manufacturer controls?

Is it suprising that the region that uses manufacturer ranges the most is also using manufacturer controls the most? That's right. 72% of our European respondents report using Manufacturer ranges. The lowest of all the regions was again Latin and South America, where only 57% respondents report using manufacturer controls. Given that ISO 15189 strongly recommends the use of third-party controls, it's a bit ironic to see that the region is the highest deviation from that best practice.

5. Who runs QC most often?

Is it surprising to see that the region running the most manufacturer controls is also running those controls more often than anyone else? 53.7% of labs responding from Europe answered that they run their controls 2 or 3 times a day. Meanwhile, in Latin and South America, only 25% of the respondents run that they run their controls 2 or 3 times a day. Europe is running their frequent controls twice as frequently as Latin and South America.

 6. Who repeats controls the most?

Nearly 90% (!) of US labs in our survey report that their first response to an out-of-control material is to simply repeat the control. Labs in the US like a do-over! Is it surprising that the country of Las Vegas and Atlantic City and many other casinos have a strong urge to roll the dice? The control vendors are thrilled whenever controls are repeated, new controls are run, and those new controls are repeated again. It's a great contribution to their profit margin.

In contrast, only 57% of the respondents from Latin and South America reported repeating their controls. It's a significant difference between the highs and lows.

7. Who repeats controls the most number of times?

We asked labs if they (1) repeated their controls, (2) ran a new control, (3) repeated the new control, and even (4) keep repeating controls until the results finally falls back in. Just over 9% of labs responding from Asia reported they did this 4th step (true gambling). Again, this behavior helps the lab not that much, but helps control vendors quite a bit. Here's where the US does better; while the labs repeat controls a lot at first, they don't keep repeating them over and over.

8. Where are the most frequent lab errors occurring?

The survey asked how often errors were occurring in the lab. In the US, not only are labs repeating controls the most, they are experiencing the most frequent errors. 29% of labs in the US report being out of control more than once a day, if not several times a day.

9. How often do labs override their QC - and report their patient results anyway?

It's a crazy thing but it happens. Labs get their out-of-control flags, but the labs decide that for one reason or another, they're still going to release patient results. While we've had a lot of positive notes from Latin and South America in this survey, here's one area where they did the worst. 19.23% of the respondents said they override their QC daily or weekly. The US has the lowest rate, only 3%. That's a big difference, 6 times more likely to override QC!

10. Where have labs done the least amount of cost management?

The survey's final question was inquiring about whether labs have taken any steps to manage their QC costs, such as reducing QC frequency, widening limits, using fewer control rules, consolidated their QC, etc. 71% of the labs from the Middle-East responding to our survey stated they had not taken any of these steps. The lowest rate of not doing anything we observed  came from Europe, where "only" 60% of labs haven't done anything. Around the world, almost two-thirds of labs have not made changes to their QC to optimize or reduce costs. As distressing as it sounds, that also means there is a big opportunity for efficiency in a lot of laboratories around the globe.

There's more, a lot more, in the data and summaries from our survey. Check it all out here: