David,
When discussing the merits of combined laboratories, it is important to
define what one means by a combined Clinical Biochemistry and Haematology
Laboratory.
I adopted the Rapid-Response and Core Laboratory model for two hospitals in
1996. Each lab has a different structure: One multidisciplinary and the
other semi-traditional.
The Rapid Response Laboratory is based in a 400 bed acute hospital and is
essentially a hot lab for Biochem, Haem and Transfusion with a limited
repertoire of testing on site. Routine and specialist work go to the Core
Laboratory. In the Rapid Response lab, the staff are truly multidisiplinary
and training is based on the IBMS document on Guidelines for Training for
Multidisciplinary Working Practices, Biomedical Scientist Feb 1997.
Technical management is by a BMS 4 from the Core Lab, who has sessions in
the Rapid Response Lab. Clinical Laboratory Leadership is by Consultant
Clinical staff (Biochemistry and Haematology). All other support, such as
Management support and Clinical Governance support, is done as one Pathology
organisation. Consultants in Clinical Biochemistry and Haematology still
have "Ownership" of the results and multi-hospital IT networking means that
Clinical Authorisation from the Rapid Response Laboratory can be done in the
Core Lab by suitably qualified staff. The 24 hour clinical advice service
is the same for all hospitals. I would have found it difficult to find the
financial and staff resources to offer a 24 hour routine service, on site,
without setting up multidisciplinary hot lab working. Therefore I woul say
that multidisciplinary working with appropriate Clinical support in a Rapid
Response lab can work well.
Our Core Laboratory does not work in a multidisciplinary way at the moment.
However there is a combined specimen Reception and Automated Laboratory for
Biochem and Haem with a BMS4 in technical charge. Most of the MLAs are
"Multidisciplinary" and load and unload the analysers. Data handling for
both sites and both disciplines is the same (one system, thin client, pre
LIMS). Multidisciplinary working at the technical level could, in theory,
be applied to an Automated Laboratory but my concern is the breadth of
skills required in Biochem and Haem labs were both Automation and Specialist
work is performed. I agree with Roger Bertholf about skill-stretch. I am not
convinced that there can be multidisciplinary BMSs that could be competent
in urgent, routine and specialist Biochem and Haem (and Immunology?).
However, the time may be right for re-defining the technical skills required
for laboratory medicine, based on technique rather than discipline.
Laboratory medicine is not just about technical skills. Clinical expertise
and Clinical Leadership, with staff educated and trained to appropriate
level (MRCPath in UK), is essential to both models of delivery.
Dr Martin Myers
Lancashire Teaching Hospitals
-----Original Message-----
From: Lloyd David [mailto:[log in to unmask]]
Sent: 29 May 2003 12:08
To: [log in to unmask]
Subject: Combined Biochemistry/Haematology labs
Dear Colleagues
I would appreciate members views as to the benefits (and pitfalls) of
combined Biochemistry/Haematology laboratories, particularly the effect upon
staff utilization.
Many thanks
David
Dr David Lloyd
Consultant Clinical Biochemist
Royal Albert Infirmary
Wigan
Tel:01942 822129
Fax: 01942 822134
email: [log in to unmask]
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