We have used the system of MLSO verification and availability of results on ward terminals immediately after validation for at least 8 years with no problem. This applies both at night and during the day [a telephoned result at night gives the same information as a ward terminal result - and is more likely to be written down incorrectly; If MLSOs are considered worthy of releasing results at night, it is insulting to say they cannot release them during the day]. Once the results are validated as technically correct there is no reason for the significantly abnormal ones to enter a siding to wait forever before a 'clinical validation' occurs. In this case all that is achieved is that the clinical staff act as chicanes on the information superhighway.
Generally when acting as duty biochemist in earlier jobs, commenting on results was a rare event - often because there was no clinical information provided which meant that any comment would be a guess in the dark. If results are worthy of comment / need interpretation, the MLSO staff bring me copies of the relevant result / people phone me up. This means that we can have a rapid result service with advice on tap. It also means that we do not have to have a senior staff member permanently sitting doing nothing so that they can instantly consider every abnormal result that comes off. To cope with such a systm I would need at least 2 extra clinical chemists, which would mean that there were more chiefs than indians.
TIM
**************************************************************************
Prof. Tim Reynolds,
Clinical chemistry Dept.,
Queen's Hospital,
Belvedere Rd.,
Burton-on-Trent.
tel: +44 (0) 1283 511511 ext 4035
fax: +44 (0) 1283 593064
email: [log in to unmask]
[alternative email for when all too frequently NHS Net isn't working [log in to unmask]]
-----Original Message-----
From: c=GB;a=NHS;p=NHS NATIONAL
INT;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK;
Sent: 20 November 2001 21:57
To: c=GB;a=NHS;p=NHS NATIONAL
INT;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK;
Subject: Out of hours clinical validation
I am currently under some pressure from our Trust Clinical Tutor supported
more or less by Pathology 'management' (who are not averse to the ancient
sport of biochemist bashing on occasion) to provide immediate ward terminal
access to all work done out of hours and at weekends. In practice this would
mean the on call BMS (many of whom are BMS1's) having to carrying out a full
authorisation.
I am loath to do this at present for a variety of reasons, not least of
which are limitations in our current IT systems
Our current system out of hours and at weekends is that all 'routine' and
most immunoassay work is run (since with modern analysers this is easier
than just doing emergency tests and having to separate samples for the next
day) but only the so called out-of -hours tests are usually phoned unless
specifically requested to provide LFT results etc. Results are validated at
the analyser and then sent across (exeption reporting based on normal
ranges)to the 'duty' biochemist for final authorisation the next routine
working day. We then use this opportunity to check the QC (a lot better with
our new analyser but we still get some stuff that is missed at technical
validation- see recent posting about magnesium), add appropriate comments or
request addition tests eg electrophoresis. At worse this means that it could
be two and a half working days before all results appear on the ward
terminal but hopefully with added value. Junior medical staff seem to want
all this at the touch of a keyboard within 2 hours of requesting it, but can
we really expect a tired MLSO to provide this at 2 o clock in the morning.
Practice locally seems to vary from one extreme to the other. According to
second or third hand information other local trusts either use BMS's to do
most of the authorisation, day or night with only the most extreme results
being refered to a pathologist or clinical scientist, or alternatively have
a pathologist or clinical scientist validating out of hours by remote
terminal from home.
A couple of questions.
1. How do other people handle this?
2. What are the medicolegal implications if I was reluctantly forced to
accept what I might regard as a lower quality system simply to appease
others?
3. What are other clinical scientists doing in response to adoption of shift
systems by MLSO staff - nothing, working shifts or working from home?
4. What is the point of having a UK NEQAS scheme for interpretive comments
if on a routine day to day basis senior clinical scientists and pathologists
see only the most abnormal results with the rest being sent out by MLSO
staff?
Gary Firth
Sussex
to allow all out of hours and weekend results to be made available
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