Jonathan's last sentence sums up many of our dilemmas.
The marginal costs of many tests are so low that the savings achieved by
their reduction can be overtaken rapidly by the costs of separate or
subsequent interventions. In addition manufacturers have to recoup their
development and production costs. The less we do, the greater the proportion
will be that is attributable to fixed costs and so unit costs of those tests
remaining will have to rise. There is even a possibility that of underming
the attractiveness of the diagnostics industry to those who invest.
Cutting out tests may have far more reaching consequences than we intially
imagine and may not lead to the benefits we expect.
Trevor Tickner,
Norwich
> -----Original Message-----
> From: Jonathan Kay [SMTP:[log in to unmask]]
> Sent: 24 July 2002 18:52
> To: [log in to unmask]
> Subject: Re: creatinine and not urea
>
> Highly positive. I'll find the data, but roughly speaking when we dropped
> the following analytes from requests which said "U and E" the residual
> workload was:
> Urea: 30%
> Chloride, bicarbonate: <5%
>
> However if you go down this route you have to be prepared to answer the
> same questions over and over again.
>
> We also have data on dropping total protein from "liver" and "bone" etc.
>
> My own view is that laboratories shouldn't define groups of assays.
> Clinicians should request groups of assays appropriate to the clinical
> need. Technology to manage this includes acronyms, rubber stamps, sticky
> labels, automated cascade, easy retrospective requesting and electronic
> patient records,
>
> But it really depends what you are trying to optimise: laboratory
> expenditure, clinical value of investigations, turnaround time...
>
> Dr Jonathan Kay
>
>
> On Wednesday, July 24, 2002, at 04:28 PM, Robin Marks wrote:
>
>
> Hello all !
>
> I would be interested to know if any laboratories have tried
> stopping measuring urea in favour of creatinine, as part of a larger panel
> ('urea and electrolytes') or otherwise.
>
> I would be interested to hear of any positive of negative
> experiences.
>
> Dr Robin Marks
> Consultant Chemical Pathologist
> Calderdale Royal Hospital
> Halifax
> HX3 0PW
> UK
>
>
>
>
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