Quality and performance indicators in Portuguese anatomical pathology laboratories: a panel validation by qualitative Delphi technique

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Background In laboratory medicine, quality and performance indicators (QPIs) are essential tools to ensure the quality of healthcare services and patient safety. QPIs allow comparison of outcomes, favouring accountability and transparency. Internationally, there are some QPI evaluation models, but the fact that they are paid limits their dissemination in smaller/poorer laboratories. In Portugal, each laboratory defines its own QPIs, with no uniformity between institutions. The development of a free QPI panel suitable for anatomical pathology laboratories (APLs) would allow for quality assessment and improvement. Objective To develop a consensual and validated QPI panel suitable for Portuguese APLs. Methods The study was developed in two stages. First, a bibliographic review was carried out, selecting the adequate QPIs. Afterwards, these QPIs were evaluated by experts through the Delphi method, where they could also suggest other pertinent QPIs. Results By the end of the Delphi method, there was a consensus on 64 QPIs (31 for 'structure', 30 for 'process' and 3 for 'result'). The consensual QPIs covered all phases of the total test cycle. The lack of specific anatomical pathology QPIs in the bibliography was noticeable. There was greater consensus on 'process' and 'result' QPIs than on 'structure'. This was supported by the bibliography, where the first ones were more valued. Nevertheless, it is important to monitor all the main laboratory processes, prioritising the evaluation of QPIs with greater impact on healthcare quality and patient safety. These results should allow APLs to identify the causes behind poor performance and improve their services. Conclusions This panel is a valuable tool for APLs, contributing to quality awareness. It can be the first step towards the development of a free benchmarking quality programme in Portugal, encouraging competitiveness and cost-efficiency.

Original languageEnglish
Article number001726
JournalBMJ Open Quality
Issue number3
Publication statusPublished - 1 Aug 2022


  • Laboratory medicine
  • Pathology
  • Performance measures
  • Quality improvement
  • Quality improvement methodologies


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