In reply to M.J. Pearson's comments, I would like to
add my thoughts.
Too often we hear questions about the effectiveness,
cost or clinical of POCT. How many times have we
thought the same about the ever increasing workload
within the laboratory?
POCT is not a new phenomenon. I remember my old
laboratory textbooks containing a chapter on "ward
side room tests". It is only with the introduction of
meters and high tech. analysers that it has come to be
of concern to laboratories.
Also we must not confuse the the use of POCT as a
tool for faster TAT e.g blood gases etc.,monitoring
sliding scale glucose in diabetics and urine dipstick
testing in Casualties, with others, such as drug
screening and cardiac enzymes. The apparent
non-success of, analysers such as the Picolo for
measuring "non-acute" tests should reassure the
laboratory that it's future is not in jeopardy.
A lot of the reasons and perhaps justification for the
increase in faster TAT,is the pressure on clinical
staff to process admissions and discharges quicker so
as to ascertain which "specialty" is required or to
release pressure on beds, and other ward "practices"
David G Brown
--- "M.J. Pearson" <[log in to unmask]>
wrote:
<HR>
<body>
<div align="left"><font face="Arial"><span
style="font-size:10pt">I'm just picking up Mike's
comments
from last month in the light of some very recent
experience here. I agree with a lot of what you
say, Mike:</span></font></div>
<div align="left"><br>
</div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">> the
few studies
reported of the clinical effectiveness of POCT do not
show major
benefits.</span></font></div>
<div align="left"><br></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">True. It is not easy to
fund
and organise high quality research in this area, but
it has
certainly been shown (eg by Kendall et al) that in
some cases only a small proportion
of patients may truly benefit clinically from POCT.
The problem is that too often
"reduced TAT" is taken uncritically as a
proxy for or synonymous with "improved
clinical and economic outcomes". Sometimes
it is, but by no means always, and this
should be examined critically when POCT is being
considered - too often, systems
are implemented simply because the clinician has the
capital funding (or has insisted
on getting it) and the decision has been made before
Pathology has been consulted.</span></font></div>
<div align="left"><br></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt"> Of
course it is nice
to </span></font></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">> do
something
at the bedside but is it effective use of resources?
If the lab can not produce a </span></font></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">>
clinically relevant
turnround time why is this? </span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">I have successfuly persuaded
many
clinicians & managers that POCT is not
appropriate in their situation, either because the lab
can provide the service they
need, or because they have not considered the
operating costs of POCT. Of
course, the opposite can arise when NHS "silo
budgeting" results in a decision by a
budget-holder that they need to save the running costs
of a POCT analyser (in a
local case, £600pa for HbA1c) despite the fact
that clinical benefits to patients are
clear and fewer admissions & clinic returns have
brought economic benefits too - but
not to the budget holder.</span></font></div>
<div align="left"><br></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">> Why
is it that
doctors and nurses who consider </span></font></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">>
themselves grossly
overburdened feel that they have the time, knowledge
and </span></font></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">>
technical -skills
to do lab tests at the bedside? </span></font></div>
<div align="left"><br></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Very good question, which
should be
asked more often. I think many clinical staff
are beginning to realise this, particularly in
connection with risk management/clinical
Governance. However, some managers have still to
lose a lot of their enthusiasm
about POCT being a wonderful thing which will solve a
lot of problems with
Pathology staffing and costs. I spoke to a
national figure in management (don't want
to name names!) who clearly thought that I was simply
trying to protect the
Pathology patch.</span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt"> </span></font></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">Why is it
sometimes
easier to obtain money for POCT than for extra
</span></font></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">> lab
staff or
to increase salaries so we can retain the ones we have
or fill vacancies?</span></font></div>
<div align="left"><br></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Another good question.
What
is needed for this and other points you've made is for
a critical, evaluative global/hospital-wide approach
to be taken. Trust POCT
committees are probably the best starting point, or
perhaps I am being unreasonably
optimistic because I've only just persuaded this Trust
that we need one.</span></font></div>
<div align="left"><br>
</div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">> With
a well managed
and adequately resourced lab there should be only
minimal need for any </span></font></div>
<div align="left"><font face="Arial"
color="#ff0000"><span style="font-size:10pt">>
hospital to have
POCT.</span></font></div>
<div align="left"><br></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">This may well be the case in
many
Trusts now, but I do think that technological
developments will change this (see previous discussion
on the mailbase). How
quickly depends not only on the technology, how simple
it is to use and how quickly it
becomes available, but also (realistically) on
financial matters - either directly in the
costs of the POCT systems, or indirectly because of
growing staffing problems in
labs.</span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">________________________________________________</span></font></div>
<div align="left"><br>
</div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Dr MJ Pearson
</span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Department of Clinical
Biochemistry
& Immunology</span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Old Medical
School</span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Leeds General Infirmary (Leeds
Teaching
Hospitals NHS Trust)</span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">LEEDS LS1
3EX</span></font></div>
<div align="left"><br>
</div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Tel 0113 392
3945</span></font></div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">Fax 0113 233
5672</span></font></div>
<div align="left"><br>
</div>
<div align="left"><font face="Arial"><span
style="font-size:10pt">http://www.leedsteachinghospitals.com</span></font></div>
<div align="left"></div>
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