Dear colleagues,
I have been interested in the discussion on this topic. I do think it
is disappointing that when there is a biochemical marker that offers
real advantages in the management of a clinical condition (see
contributions by Paul Collinson), so many appear to find it necessary to
restrict its availability. This is in contrast to the routine "urea and
electrolytes" or "liver function tests" that are usually freely
available but often of doubtful utility.
The reasons usually given are lack of resources and concern about
misuse. The resource issue can be addressed through clinical budgeting
(discussed in the Annals recently) and through use of the NSF funding
which we otherwise find it difficult to get our hands on. The misuse
issue needs to be tackled through audit. Clinicians are generally
sympathetic to this type of monitoring and we have been able to feed
back to our clinicians evidence of apparent misuse (e.g. frequent
repeats on the same patient.)
As well as its use in the chest pain cases where colleagues rightly
point out that it may not result in quicker thrombolysis in obvious
cases, it has prognostic significance in cases where the e.c.g. is
normal or equivocal and is extremely useful in cases of collapse in
older people where the cause may be difficult to determine. It is also
useful in post-surgical problems where myocardial infarction may be the
cause of poor recovery from an operation but symptoms are masked by the
effects of the operation and concomitant medication.
All hospitals now operate on a 24 hour a day 7 day a week basis. We
need to offer a similar service for tests that are critical. After all,
the laboratory service is there to add value to the clinical service of
the hospital, not to provide a "raison d'être" for phlebotomists. It is
the perceived lack of such a 24/7 service that is one of the drivers for
Pathology Modernisation (and similar limitations on the radiology
service are also in the government's sights). With current technology,
nearly all departments can offer these tests all the time. Even those
clinicians who reluctantly accept a twice a day batch service would
probably prefer 24 hour availability and at weekends. If we are not
making such tests available, when there is a strong case to be made for
them, perhaps we should examine very closely our reasons for not doing
so.
Trevor
--
Trevor Gray
Dept. of Clinical Chemistry,
Northern General Hospital,
Sheffield S5 7AU
0114 271 4309
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|