Assay error detection when using common quality control targets across multiple instruments: an analysis using simulated and real-world data.

Background Clinical laboratories frequently implement the same tests and internal quality control (QC) rules on identical instruments. It is unclear whether individual QC targets for each analyser or ones that are common to all instruments are preferable. This study modelled how common QC targets influence assay error detection before examining their effect on real-world data. Methods The effect of variable bias and imprecision on error detection and false rejection rates when using common or individual QC targets on 2 instruments was simulated. QC data from tests run on two identical Beckman instruments (6-month period, same QC lot, n>100 points for each instrument) determined likely real-world consequences. Results Compared to individual QC targets, common targets had an asymmetrical effect on systematic error detection, with one instrument assay losing detection power more than the other gained. If individual in-control assay standard deviations (SDs) differed then common targets led to one assay failing QC more frequently. Applied to 2 analysers (95 QC levels, 45 tests), common targets reduced one instrument's error detection by ≥0.4 sigma on 15/45 (33%) of tests. Such targets also meant 14/45 (31%) of assays on one in-control instrument would fail over twice as frequently as the other (median ratio 1.62, IQR 1.20-2.39) using a 2SD rule. Conclusions Compared to instrument-specific QC targets, common targets can reduce the probability of detecting changes in individual assay performance and cause one in-control assay to fail QC more frequently than another. Any impact on clinical care requires further investigation.