I hadn't seen this, so I'll follow it up - thanks, Janice. I'll be interested to
see how much involvement in planning and management the lab
service had in this case.
i-STAT was initially marketed as a total hospital cost-saving solution,
generally by bypassing the lab. HP tried that here some years ago,
approaching our finance & supplies department (who immediately
passed it on to us!). We expressed an interest in trialling it in limited
areas, but never got any response. It was all or none then, apparently.
The marketing strategy is more realistic now, but the argument is still
that the NHS is too hung up on "silo budgeting" - ie the total savings to
the hospital should be considered in decision-making, not just the
impact on the budget of the user dept. Fair point, but I think this is still
ignoring an aspect of human behaviour with which we in the lab are
familiar - the easier, faster and more accessible a test is, the more it will
be used, often in an apparently ritualistic or reflex way rather than a
considered "do i really need this result?" way - even more likely in
acute/critical care areas when clinical staff are under pressure.
There will always be a spiralling use of such simple and accessible
technology, with resultant huge costs, unless there is careful intial
planning, with clear agreed procedures for its use and clear
responsibilities for management of analysers and cartridges. This will
continue to be the case as more and more simple to use POCT systems
come on to the market.
JP
> The article says that i-Stat was chosen as a cost
> saving exercise when they wished to close their ITU
> hot lab. Their use spiralled and costs were huge. The
> most worrying problem was clinically significant
> discrepant values for PCO2 which would have resulted
> in altered patient treatment.The errors were not noted
> with either QC or QA material or the electronic
> checks, but were evident with blood samples.As they
> could not identify a cause, and fearful of litigation
> or adverse patient event the whole system was
> scrapped.
>
> I also have a paper Clin Chem 47(11):2064-6,2001 Nov
> which refers to discrepant chloride values with
> samples with elevated ureas.
>
> Regards Jan
>
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