>>> Robert Forrest <[log in to unmask]> 10/01/03 01:54pm >>>
How about impact on potential litigation costs?
Robert Forrest
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Good point, particularly with the possible implications of CE marking of POCT devices. I'm looking into this at the moment, but I'm very concerned about the implications of use/misuse of POCT devices by possibly untrained users, at variance with the instructions of the manufacturer. I'm told that clarity about this is only likely to emerge as case law develops. The aim, I think, is to ensure that you/your department/your trust do not find yourselves contributing to case law.
There is in any case plenty of clear guidance about POCT Managers' clinical governance responsibilities and the importance of training for the use of IVD devices (eg CNST standards and MDA guidance 2002). If your Trust is aiming to get from CNST level 1 to level 2, it will save several £100,000s and effective risk management in POCT - for which you will need staff - will contribute to that.
As for your other points, Phil, there are publications indicating that implementation of POCT can save the hospital money, and others which show that it doesn't - it depends on the test, the organisation and how the study was done. Similarly, reports of effects on length of stay are variable. Your best bet would be to look up Chris Price's publications on POCT clinical and economic outcomes.
Implementation of POCT does not necessarily result in reduced requesting of that test from the lab - there is a tendency of clinical users to send duplicates to the lab "just to make sure". Danielle Freedman et al showed in a survey some years ago that far more clinicians trusted lab results than POCT. The best way of keeping confidence high and limiting/preventing double testing is to ensure the quality and appropriateness of the POCT system by working with the clinical area, training their staff, ensuring that they use QC and EQA and that there is someone from the lab to answer queries/troubleshoot. For that you will need POCT Officers. Having people in this role, together with a Trust POCT Policy is the best way of preventing uncontrolled implementation of inappropriate systems which waste the Trust's money and potentially increase risk.
If you do not have oversight of POCT throughout your Trust, uncontrolled implementation (which will happen) will waste resources and put patients at risk.
JP
-----Original Message-----
Dear All
We are trying to establish POCT officer posts in this trust and our
finance director is asking for a business evaluation to address such issues
as:
Impact on length of stay
Impact on avoidance of admissions
Impact on workload and costs in pathology
Is there anybody who has jumped through this particular hoop who can offer
advice or suggest any relevant publications?
Phil
Dr MJ Pearson
Department of Clinical Biochemistry & Immunology
Old Medical School
Leeds General Infirmary (Leeds Teaching Hospitals NHS Trust)
LEEDS LS1 3EX
UK
tel (44)-113-392-3945
fax (44)-113-343-5672
http://www.leedsteachinghospitals.com
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