The rule of thumb for point of care vs the main lab should not be "every
good ICU has one" but is the need for a rapid at the patient bedside test
warranted i.e. does it have clinical utility when the lab can provide a
similar result but with a longer, but not onerous, TAT especially in light
of the fact that POC tests cost 10x the cost of the same test done in the
lab.
Let me give some examples:
POC cardiac markers from the ED, at my institution we were able to remove
them from the ED because we were able to improve our troponin TAT
significantly (from order to test result as well as most of the phases) and
there are still some bottlenecks that will improve the TAT even better.
Inpatient glucose, there is no question that POC glucose monitoring for
diabetic inpatients has great utility since it allows for timing of insulin
in relation to arrival of meals and it eliminates the hit or miss of waiting
for a main lab glucose result to show up but to replace AM labs because it
is more efficient for clinician rounds, in my opinion, doesn't warrant its
use.
In my opinion, the utility of the particular POC test in relation to its
intended use need to be justified along those lines, i.e. where a rapid
bedside result is going to have more of a clinical impact than waiting for
the result from the lab when a STAT request is unfeasible.
David Alter, MD
Clinical/Chemical Pathologist
Spectrum Health
Grand Rapids MI
-----Original Message-----
From: David Brown [mailto:[log in to unmask]]
Sent: Wednesday, December 11, 2002 9:27 AM
To: [log in to unmask]
Subject: Re: Mini-labs
I feel this is a bit "closing the stable door after
the horse has bolted". POCT has been expanding at an
increasing rate for the past 20yrs or so. The
discussion regarding "what is worth doing" is
supposed to be one of the first steps towards
accepting responsibility for POCT. I think the labs
have to prove, consistently i.e. "no bad days" they
can deliver suitable turnaround times 24hrs a day, 7
days a week. There are hospitals that already have
"mini labs" in ICU's, theatres and A&E. Try telling
them to convince their users that sending samples to
the lab is best. Most labs don't really have much of a
choice in the matter. As you know, one of the main
reasons for the expansion of POCT, is the Consultant
saying "every good ICU or Casualty has one".
The lab. then has 2 choices, ignore it and let the
Unit that has POCT look after themselves or take part
in the discussion of how to ensure they have the best
equipment and training for the job.
David G Brown
--- "White.Phil" <[log in to unmask]> wrote: > I
agree Richard, I am concerned about the creation
> of mini-laboratories
> around the hospital. I have to admit however that in
> this laboratory our
> turn-around times can be embarrassingly long
> particularly on 'bad days'. In
> my view investment in improving result turnaround
> times is preferable to
> expanding POCT.
>
> Phil
>
> -----Original Message-----
> From: Mainwaring-Burton Richard (RGZ)
>
[mailto:[log in to unmask]]
> Sent: 10 December 2002 18:10
> To: [log in to unmask]
> Subject: Paracetamol & Salicylate levels.
>
>
> It would be useful (interesting to me) if data could
> be includ other tests
> done on the patient at the same time or
> chronologically close.
> I feel major discussion coming on relating to which
> tests are worth doing at
> the bedside.
> I would surmise that a significant number of
> concurrent U&E (or even 'basal'
> LFT) requests are made with the sal+par and so you
> might as well let the lab
> do the test and not bother the A&E department staff
> with becoming MLSO's -
> surely they have enough to do already ! and with
> turning part of the
> clinical area into a mini-lab with all the Health &
> safety implicatoins
> thereof.
>
> Any views ?
>
> With best wishes
> Richard
> Biochemistry Department
> Queen Mary's Hospital
> Sidcup, Kent
> DA14 6LT
>
>
>
> -----Original Message-----
> From: Dale, Christina
> [mailto:[log in to unmask]]
> Sent: Tuesday, December 10, 2002 15:57
> To: [log in to unmask]
> Subject: Paracetamol & Salicylate levels.
>
>
> Dear All,
>
> I am currently validating a point of care test for
> the presence of
> paracetamol and salicylate. As part of background
> research it would be
> invaluable to get an idea as to how many paracetamol
> and salicylate assays
> are done and what proportion of them are negative
> (<10mg/l and <50mg/l
> respectively).
>
> So far twelve hospitals, mainly in the North Thames
> Region, have sent me
> their data but my aim is to get as many as possible
> nationwide.
>
> I would be very grateful if you could send, fax or
> e-mail the following
> data:
> - Number of paracetamol and salicylate
> assays carried out during the
> year 2001.
> - Number of paracetamol and salicylate
> levels <10mg/l and <50mg/l
> respectively.
> I do not need any patient
> information for this.
>
> The Multi-Centre Research Ethics Committee have
> approved this survey and I
> would be happy to forward a copy of their letter if
> you have any concerns.
>
> I would be most appreciative if you could help me
> with this task, please do
> not hesitate to contact me if you have any
> questions.
>
> Thank you,
> Yours sincerely,
>
> Dr Christina Dale,
> Research Fellow,
> Academic Department of Accident and Emergency
> Medicine,
> St Mary's Hospital,
> South Wharf Road,
> London, W2 1NY.
>
> Tel: 020 7886 6079
> Fax: 020 7886 6315
> Email: [log in to unmask]
>
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------ACB discussion List Information--------
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community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
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they are responsible for all message content.
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List Instructions (How to leave etc.)
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------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
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