Surely, we add value in our clinical activities (lipid clinics etc for the medics) and our interpretation / advice. We don't add value by being penny-wise (saving a few pennies by blocking some tests) but pounds-foolish (at the cost of lots of our time). It only makes sense to have automatic systems that warn the requester that their request has already been done and do they really want to repeat. If they continue the request, then we have to be very careful about refusing the test unless we personally evaluate all of the data on that patient (including their current clinical condition on the ward as they may have suddenly worsened).
A similar problem is the question: How can you define what is an unnecessary test: I tried years ago in an audit of on-call testing. What was unnecessary in the retrospectoscope of Monday morning was valuable reassurance at midnight on Saturday, allowing a paranoid junior to go to bed [Personally, I thought that was why you had nurses].
- to tell you the patient had gone off and advise you to get out of bed to see them, what else did you think I could mean.
TIM
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Clinical Chemistry Department,
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> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]]On Behalf Of Robert Forrest
> Sent: 18 December 2003 15:14
> To: [log in to unmask]
> Subject: Re: Duplicate requesting
>
>
> That raises a very serious issue. Do chemical pathologists
> and clinical
> biochemists add value commensurate to their cost of
> employment over and
> above the contribution made by well trained MLSOs in the "factory"
> laboratories? Does blocking a few duplicates justify our
> existence in either
> clinical or financial terms? Some duplicate testing has to be
> accepted as a
> consequence in the lack of continuity of medical care that is
> now the norm
> in the UK.
>
> Really, I suppose this comes down to the fundamental issue of the
> documentation that accompanies samples; are they "orders" or
> "requests". If
> they are orders and are accepted as such by that nice Dr Reid and his
> appatchiks then our days must be numbered, despite RCPath,
> ACB and CPA's
> fulminations. Pile the tests high and sell them cheap...
>
> Robert Forrest
>
> "I was only obeying orders"
>
> "Ah, but were you not aware that only lawful orders need be obeyed?"
>
> Exchange between defendant and prosecutor at Nuremberg.
>
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]]On Behalf Of Colley, Michael
> Sent: 18 December 2003 14:33
> To: [log in to unmask]
> Subject: Re: Duplicate requesting
>
>
> But if most of it's done by computer, isn't part of our
> function to advise
> on appropriate testing. Messages can be attached as an
> educational aid.
>
> If we're just going to do everything that's asked then all
> Biochemists and
> Chemical pathologists might as well pack up and go home, WITHOUT the
> facility to access their lab computer remotely!
>
> Michael
>
> -----Original Message-----
> From: Paul Eldridge [mailto:[log in to unmask]]
> Sent: 18 December 2003 13:12
> To: [log in to unmask]
> Subject: Re: Duplicate requesting
>
>
> Trapping requests to vet pre analysis cannot be worth the expert time
> involved.
> It would cost more in my time to cancel a request than the savings in
> reagents. By the time the request and sample have reached the lab and
> been entered into our systems MOST of the resources costs have already
> been used.
> Most of us have tried it in the past and realise that there are more
> constructive things to do in life.
> The major costs to a lab in duplicate testing are the bulk cheap tests
> - and TFTs are now cheap.
> It must be part of the specifications of an order comms system so that
> the requester is alerted and given the opportunity to over-ride as
> needed.
> Much hospital based requesting is now based on protocols.
> Our expert time must be with the clinical teams involved in designing
> which tests and their frequency to be built into the protocols.
>
> My post lab Xmas party rant !
>
> Dr Paul Eldridge
> Clinical Biochemist
> University Hospital Lewisham
> London SE13 6LH
> UK
> Phone: (44) 020 8333 3255
> Fax: (44) 020 8690 8891
>
>
> [log in to unmask]
>
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