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The Key Incident Monitoring and Management Systems (KIMMS) aims to monitor the pre- and post-analytical phase of the laboratory quality system and is designed to provide pathology practices with the tools for continuous measurement and monitoring of key incident quality indicators.
Data for the survey is entered into the result entry tab in the myQAP portal. A list of all incidents captured and measured by the KIMMS program can be found here. Instructions to input the incidents recorded by participants will be provided when the survey opens.
KIMMS Report
Analysis of Results
Participants are asked to capture the number of episodes and the number incidents per quarter of the year.
An episode is usually covered by a single request and may consist of one or more samples. It may include more than one request, but the samples are collected at the same time: i.e. samples received together in a bag with a request form equals one episode.
All incidents recorded should be counted, whether they lead to rejection or not.
Each specific incident reported to KIMMS is calculated per 100,000 episodes (number of incidents divided by the number of episodes, multiplied by 100,000), known as the rate. Incidents recorded from “test requests”, “collection” and “transport and storage” are separated into the number of episodes recorded from inpatient, outpatient, community, emergency department and mixed options.
Incidents recorded from “test registration”, “analytical” and “post analytical” are calculated against total number of episodes.
Incident rates are compared to peer groups, and flagged red if outside the best performers, which is set at 80% of all results.
An example of the analyses is provided below.
Survey:1 KM-23-01
Inpatient Episodes:2 536502
Outpatient Episodes:2 101011
Community Episodes:2 150
Emergency Department:2 102052
ALL EPISODES:3 739715
| Unlabelled specimen or request10 | 130 | 24.2 | 28.0 |
| Insufficient patient ID specimen or request10 | 230 |
43.08 |
40.0 |
| ID mismatch between specimen and request10 | 287 | 53.0 | 60.0 |
| Specimen from wrong patient10 | 3 | 0.6 | 0.8 |
| Inpatient4 – Collection Identification Incident5 | Results6 | Rate7 | 80% cut-off9 |
Cumulative results
Results are plotted cumulatively on a continuous line graph. A graph for each option and incident type is presented in reports, showing rates for the last six surveys.
Overall Performance Summary
The overall performance summary highlights any “incident” that recorded a rate greater than 80% of all participants. This is presented in a table, which includes columns for the Consequence, Probability and Detectability rating (tables 1-3). The KIMMS Advisory Committee has pre-determined the consequence rating so this field is pre-populated.
|
Parameter out of allowable limits
|
Consequence rating
|
Probability Rating
|
Detectability rating
|
Risk Score
|
Organisational response
|
| Inpatient – haemolysis rate = 400 |
2 |
5 |
1 |
10 |
Example: Although this is a low risk incident, high compared to peers and to our collectors (0.2). Meeting with hospital organised 7/10/22 |
The light blue text highlights the results participants needs to complete.
All reports are available in myQAP on the Reports tab and a guide to interpret the report will be available on the RCPAQAP website.
Result review
It is recommended that participants review their results by applying the probability and detectability rating to determine the risk score (Tables 1-3). The risk score is calculated by multiplying the three ratings (consequence rating x probability rating x detectability rating). : The risk score can be used as a guide to organisational risk, and from that, a decision is made as to the next step(s).
In the above example, the consequence, probability and detectability rating give a risk score of 10. This would be considered low risk. Apart from flagging that the risk is higher than other participant inpatient collections, it is unlikely that any further immediate action is required. This incident should be monitored closely to ensure it does not deteriorate.
Risk Score
The score is calculated by multiplying the consequences (Table 1) x probability (Table 2) x detectability (Table 3)
Table 1: Consequence scale
|
Scale
|
Name
|
Definition
|
| 1 | Negligible/Minimal | Minimal, delay, inconvenience |
| 2 | Marginal/Minor | Recollect required |
| 3 | Significant/Moderate | Delayed management (non-malignant) and/or medical treatment |
| 4 | Serious/Major | Delayed diagnosis (malignant) and/or surgical treatment |
| 5 | Critical/Catastrophic | Serious harm to multiple patients and/or patient death |
Table 2: Probability scale
|
Scale
|
Name
|
Example Definition
|
| 1 | Rare | <1/year |
| 2 | Unlikely | 1 per year |
| 3 | Occasional | 1 per month |
| 4 | Likely | 1 per week |
| 5 | Frequent | 1 per day or more |
Table 3: Detectability scale
|
Scale
|
Name
|
Definition
|
| 1 | Detected | >95% |
| 2 | Most detected | 75-95% |
| 3 | Half detected | 25-75% |
| 4 | Most not detected | <5-25% |
| 5 | NOT detected | <5% |
References
Survey number: Year and survey number.
Option episodes: Episodes that were received from a specified location.
All episodes: Total number episodes from all location options.
Option.
Category: Incident categories comprise test request, collection, transport and storage, test registration, analytical and post analytical.
Raw result: As reported to KIMMS by the participant.
Rate: Incidents per hundred thousand episodes “Calculation = result / episodes) x 100,000”. From the example above “rate for unlabelled specimen or request” = 130 / 536502 x 100,000.
Result assessment: If the incident rate is higher than 80% of the best performing participants, the incident is flagged as requiring review. These incidents will be listed in the report summary of the report.
80% cut-off. Results will be calculated from all results received.
Specific incident.