The question regarding chloride measurement is, surely, a microcosm of a
general problem that faces laboratories.
The clinical value of any test is the clinical benefit accruing from the
true positives and negatives less the harm generated by the false positives
and negatives.
The resource value of inclusion of a test within a profile is cost of any
cascade mechanism (be it rule based within the laboratory or dependent upon
fresh requesting and sampling outside) less the cost of its automatic
inclusion. Reduction in test numbers may not equate to a true overall
reduction in workload or cost.
The political value is the perceived value of the test by clinician or
patient (possibly less any accolade from the managers for containing cost).
Whether a laboratory is right or wrong to offer inclusion of tests depends
upon the interaction of these considerations which may vary from site to
site.
Unfortunately most of the evidence upon which we can base our assertions
appears to be anecdotal. It might help if we could devise an objective scale
that balanced these (and no doubt other) pressures.
Trevor Tickner,
Norwich
> -----Original Message-----
> From: Loughrey, Clodagh [SMTP:[log in to unmask]]
> Sent: 08 January 2001 13:12
> To: [log in to unmask]
> Subject: Re: Usefulness of chloride measurement
>
> And similarly in Belfast:
>
> Requesting patterns over 6 months were compared between 2 teaching
> hospitals
> in Belfast, whose laboratories recently merged (abstract submitted for
> Focus
> 2001). Clinical spectrum of each hospital is broadly similar. In hospital
> B,
> Cl and CO2 are requestable on a profile; in hospital R, the corresponding
> profile is much smaller and Cl and CO2 must be specifically requested.
>
> In hospital B, approx 31.4% of all requests received asked for Cl, 29% for
> CO2. In hospital R, corresponding stats were 5.4% (Cl) and 4.8% (CO2).
> These
> translate into approx 70,000 requests for each analyte per annum in
> hospital
> B, and about 10,000 each in hospital R. Although a considerable reduction
> in
> workload is apparently achievable by making Cl and CO2 available by
> specific
> request only, the clinicians, at least in hospital R, would certainly
> notice
> if it was removed completely.
>
> Dr Clodagh Loughrey
>
>
> -----Original Message-----
> From: Jonathan Kay [mailto:[log in to unmask]]
> Sent: 08 January 2001 11:26
> To: [log in to unmask]
> Subject: Re: Usefulness of chloride measurement
>
>
> Similar experiences here in Oxford:
>
> Reduction of workload by redefinition of test profiles
> McVittie,J.D., Kay,J.D.S., Keenan,J.
> Poster presentation
> National meeting of the Association of Clinical Biochemists, 1988
>
> All assays still offered, but clinicians need to ask for them by name,
> rather than group.
>
> Chloride, bicarbonate, gammaGT, total protein fell to very low workload,
> urea to about 30% of previous level.
>
> Dr Jonathan Kay
>
> ...............
>
> Dr CS Ho wrote:
>
> > It is interesting to see the heated argument on this topic. Back in
> > the 80's, our department include both chloride and bicarbonate as part
> > of renal function test. We had around 300 chloride measurement per
> > day. Then we redefined renal function test without chloride and
> > bicarbonate. The clinicians had to specifically request these 2
> > tests. We had less than 10 requests of chloride per day. Eventually
> > we removed these 2 analyses from the big Parallel analyzer and
> > measured them in other smaller analyzer. This experience showed how
> > useful is "routine" chloride measurement in the eyes of the requesting
> > clinicians.
> >
> > Dr CS Ho
> > Scientific Officer (medical)
> > Department of Chemical Pathology
> > Prince of Wales Hospital, Shatin, NT, Hong Kong
> > Online Status:[Image]
> [Image] [Image]
>
> >
>
>
---------------------------------------------------------------------------
The information contained in this e-mail is confidential and is intended
only for the named recipient(s). If you are not the intended recipient you
must not copy, distribute, or take any action or reliance on it. If you have
received this e-mail in error, please notify the sender. Any unauthorised
disclosure of the information contained in this e-mail is strictly
prohibited.
|