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Combined Shewhart-Cusum control chart for improved quality control in clinical chemistry
Abstract
We describe the adaptation of the decision limit cumulative sum method (cusum) to internal quality control in clinical chemistry. With the decision limit method, the cusum is interpreted against a numerical limit, rather than by use of a V-mask. The method can be readily implemented in computerized quality-control systems or manually on controls charts. We emphasize the manual application here and demonstrate how the technique can be implemented on existing Shewhart or Levey-Jennings control charts. This permits both cusum and Shewhart control rules to be used simultaneously on a single control chart and also minimizes the data calculations necessary for the cusum method. Computer simulation studies are used to determine the performance characteristics of several different cusum rules, alone and in combination with a Shewhart rule. These studies indicate that improvements in existing quality-control systems should be possible by addition of this simple cusum method and by use of a combined Shewhart-cusum control chart. This should be particularly advantageous when introducing the cusum method in laboratories with manual quality-control systems.
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In the citing paper
“Error approaches, including frequentist statistics, are widely used for quality control in laboratory medicine.20,22,73,74”
From Uncertainty in Measurement and Total Error (2017) · cites this paper as [73]
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Sequential Changepoint Detection in Quality Control and Dynamical Systems
Lai, T. L. (1995) · Journal of the Royal Statistical Society Series B (Statistical Methodology) · doi:10.1111/j.2517-6161.1995.tb02052.x · Cited by 581
Combined Shewhart-CUSUM Quality Control Schemes
Lucas, J. M. (1982) · Journal of Quality Technology · doi:10.1080/00224065.1982.11978790 · Cited by 450
Correlates of Markers of Oxidative Status in the General Population
Trevisan, M. (2001) · American Journal of Epidemiology · doi:10.1093/aje/154.4.348 · Cited by 351
“The mean value ± two standard deviations was then calculated as the acceptable range for all control materials, which were regularly evaluated by means of decision limit cusum analysis of LevyJennings control plots (17) and Westgard multirule charts (18).”
MethodGuidance for laboratories performing molecular pathology for cancer patients
Cree, I. A., Deans, Z. C., Ligtenberg, M. J. L., Normanno, N., Edsjö, A., Rouleau, É., Solé, F. G., Thunnissen, E., Timens, W., Schuuring, E. M. D., et al. (2014) · Journal of Clinical Pathology · doi:10.1136/jclinpath-2014-202404 · Cited by 223
Self-Starting Cusum Charts for Location and Scale
Hawkins, D. M. (1987) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.2307/2348827 · Cited by 214
Metadata
- Authors
- Westgard, J. O., Groth, T., Aronsson, T., & de Verdier, C. H.
- ORCID
- Westgard, J O
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 1977-10-01
- Volume
- 23
- Issue
- 10
- Pages
- 1881-1887
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- OpenAlex
- W2136487613
- Cited by
- 138
- References
- 0
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 9 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 3 · 2015: 6 · 2014: 2 · 2013: 5 · 2012: 6
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Advanced Statistical Process Monitoring
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Physical Sciences › Engineering › Control and Systems Engineering › Fault Detection and Control Systems
- Keywords
- Shewhart control charts, CUSUM control chart, internal quality control, Levey-Jennings charts
- MeSH terms
- Chemistry, Clinical, Computers, Decision Making, Models, Theoretical, Probability, Quality Control
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