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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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IMPACT FACTOR 2016: 3.432

CiteScore 2016: 2.21

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Source Normalized Impact per Paper (SNIP) 2016: 1.112

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Volume 49, Issue 11


Practical application of Sigma Metrics QC procedures in clinical chemistry

Christian H.H. Schoenmakers / Andre J.M. Naus / Henricus J. Vermeer
  • Department of Clinical Chemistry, Tergooiziekenhuizen, Hilversum and Blaricum, The Netherlands since September 2010; Department of Clinical Chemistry and Haematology, Albert, Schweitzer Hospital, Dordrecht, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Douwe van Loon / Gerard Steen
Published Online: 2011-07-29 | DOI: https://doi.org/10.1515/cclm.2011.249


Background: Many labs have not yet selected the most appropriate Westgard Quality Control (QC) rule for each test. This is mainly due to the apparent complexity of the matter.

Methods: From the Westgard OPSpecs Charts QC planning tool and the Sigma Metrics formula's it was deduced that every Westgard rule has its own Sigma value. This was converted to an easy three-step road map to optimal Westgard QC rules.

Results: The road map provided is based on Sigma Metrics that hold a definition of “world class quality”, at which no further effort to increase quality needs to be taken. Furthermore, it is shown that clinical chemical tests can be classified as “good”: quality at or above world class, “bad”: quality below world class but controllable with Westgard QC rules and “ugly”: quality not controllable with Westgard QC rules alone. Finally, practical tips of how to deal with this and related aspects are given.

Conclusions: The use of the road map based on Sigma Metrics leads to fast and easy implementation of optimal Westgard QC rules.

Keywords: practical application; quality control procedures; Sigma Metrics; six Sigma; Westgard rules

About the article

Corresponding author: Dr. Christian H.H. Schoenmakers, AKL, Elkerliek Ziekenhuis, PO Box 98, 5700 AB Helmond, The Netherlands Phone: +31 492 595052, Fax: +31 492 595059,

Received: 2010-12-15

Accepted: 2011-06-27

Published Online: 2011-07-29

Published in Print: 2011-11-01

Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 49, Issue 11, Pages 1837–1843, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm.2011.249.

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©2011 by Walter de Gruyter Berlin Boston. Copyright Clearance Center

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