Spirometry data review Copy

Spirometry data review

High quality spirometry tests are essential for correct interpretation and classification of worker respiratory health. If the OMP or OHNP concludes that spirometry results are not reliable, workers may need to be re-tested and the effectiveness of the entire worker monitoring program may be called into question. Therefore, facilities conducting occupational spirometry tests should establish on-going programs of regular quality assurance reviews of spirograms and calibration check records.

Quality assurance reviews should be conducted by individuals experienced in recognizing and correcting flawed spirometry tests, such as the OMP, the lead OHNP or an external third-party spirometry specialist. Randomly selected test reports, all invalid tests, and a sampling of tests with unusually low or high results (e.g., FEV1 or FVC below LLN or >130 percent of predicted) should be examined. Though electronic tracings and records are evaluated most efficiently, hard-copy reports can also be reviewed. Reviews should be performed at least quarterly and more often if the operator is inexperienced or if poor technical quality is observed. Reports on test session quality should be prepared monthly, or at least quarterly, for each operator.

After the quality assurance review, feedback to the operator should focus on evaluating his/her coaching skills and understanding of the elements of a valid spirometry test. The operator should also be allowed to provide feedback to the quality assurance reviewer. Periodic discussions between the operator and reviewer should include:

  1. Frequency and type of technical errors causing unacceptable curves and the frequency of nonrepeatable tests
  2. Coaching actions that the operator can take to improve test quality
  3. Positive feedback for good performance
  4. Comments regarding spirometer configuration settings and formatting of reports of test results
  5. Feedback from the operator about what can be done to improve spirometry results (e.g., providing workers with educational materials or better storage and maintenance of equipment).

The goal is to insure that at least 80 percent of spirometry tests are technically valid3. Supervision or retraining of a operator is indicated when the overall spirometry test quality falls below an 80 percent success rate.

The importance of a quality-control programme that continuously monitors individual operator performance and with feedback to operators in obtaining adequate spirometry results is critical to the collection of high-quality data.