The Newborn Screening Ontario Submitter Quality Indicator Report
Newborn Screening Ontario (NSO) has developed tools and metrics to help hospitals and midwifery practices gauge whether they are using the current screening system optimally and to ensure timely and high quality screening for infants in their care. The reports are distributed on a quarterly basis and provide information about five key newborn screening (NBS) performance indicators:
- Dried Blood Spot (DBS) Transit Time Indicator
- DBS Unsatisfactory Specimen Indicator
- DBS Age at Collection Indicator
- DBS Requisition Completion Indicator
- Critical Congenital Heart Disease (CCHD) Age at Screening (by Pulse Oximetry) Indicator
DBS Specimen Transit Time: A site specific graphical report showing the time it takes from the collection of a NBS dried blood spot (DBS) specimen to its receipt at NSO. Data is displayed based on the day of the week the specimen is collected and includes all specimens received at NSO during the period of the report.
This indicator is sensitive to weather or courier related delays but does take into consideration the geographical location of your facility or practice and whether the courier system is able to provide weekday overnight delivery of your specimens to NSO, and whether Friday night pick-up for Saturday delivery, and Saturday pick-up for Monday delivery at NSO are courier options available to you.
Please click here for information about how to interpret the DBS Transit Time Indicator
If weekend pick-up and delivery options are available from your location, and you are not taking advantage of them, you may notice an increase in ≥ 1 day transit times. Submitters from more remote Ontario sites will be pleased to find the report should better reflect their performance taking into consideration the courier services currently available at their location. For more information about DBS specimen transit times, please go here: https://www.newbornscreening.on.ca/en/health-care-providers/submitters/r...
DBS Unsatisfactory Specimens: A site specific graphical report showing the number of NBS specimens received during the report period which were reported by NSO as unsatisfactory. This indicator includes an itemization of the reasons why specimens were reported as unsatisfactory and permits comparison to the provincial trend.
This indicator is useful for highlighting the most common reason(s) why specimens collected at a hospital or midwifery practice are rejected so that changes to collection practices may be considered.
Please click here for information about how to interpret your Unsatisfactory Specimen Indicator.
As of July 29th 2019, NSO has made improvements to the process for screening and reporting DBS specimens which are not of sufficient quality and/or quantity to complete the entire NBS panel. NSO performs “partial panel” screening on DBS specimens which are deemed acceptable to produce good quality results for the most aggressive or early presenting diseases. A repeat DBS specimen is still required as soon as possible to complete the balance of the screening tests. DBS specimens for which we are only able to complete a “partial panel” are still considered unsatisfactory and included in the Unsatisfactory Specimen Indicator count.
Age at Collection: A site specific graphical report providing information about the timing of NBS specimen collection by a hospital or midwifery practice. Only data for initial specimens is included in this report. The indicator displays the “Age at Collection” (in days) on the x-axis and the “Cumulative Percent Specimens Collected” on the y-axis. The “Cumulative Percent Specimens Collected” is the running total of all of the specimens collected between birth and the age specified on the X axis, expressed as a percent of the total number of specimens collected during the period of the report.
This indicator may be helpful for guiding operational processes aimed at accommodating the NSO recommended age for initial NBS specimen collection.
Please click here for instructions on how to interpret the Age at Collection Indicator.
As of July 29th 2019 and the launch of the new NSO laboratory Information System, Birth and Collection Time are included in the same field as Date of Birth and Collection. Therefore time of birth and collection can no longer be determined as missing from the requisition if the Date of Birth and collection are provided. The time of birth and DBS collection remain critical pieces of information required to determine the age at specimen collection especially for specimens collected near the minimum 24 hr. recommended time.
Requisition Completion Indicator: The Requisition Completion Indicator displays the percent-completeness of key fields on the newborn screening (NBS) blood collection device and includes all NBS specimens received by NSO from your institution or midwifery practice during the period of the report. These critical fields are used for the purpose of identifying and linking newborns with previous screening specimens and to locate the family or healthcare provider in the event of a screen positive result. Some demographic information is incorporated into the disorder logic used to interpret screening results. Missing, incomplete or improbable information in any of these fields on the requisition necessitates follow-up by NSO staff to obtain this information resulting in unnecessary delays in the infant’s screening process and creating un-necessary work for you and NSO.
Please click here for instructions on how to interpret the Requisition Completion Indicator.
Critical Congenital Heart Disease (CCHD) Age at Screening Indicator: Since 2017, NSO has been collaborating with hospitals and midwifery practices to support quality, standardized CCHD pulse oximetry screening for Ontario babies. The goal of screening is to increase the detection rate of CCHD in affected newborns prior to clinical deterioration. NSO’s role is to collect CCHD screening results for quality assurance and program evaluation purposes.
The recommended time to perform CCHD screening is between 24-48 hrs. of age, optimally between 24-36 hrs. For more information about CCHD screening please go here: https://www.newbornscreening.on.ca/en/health-care-providers/submitters/cchd-screening-implementation
For further inquiries, or for recommendations as to how we might improve this report, please contact Christine McRoberts (NSO Laboratory and Quality Manager).