Jonathan et al
Current normal lab system with air tubes, 24/7 with closely monitored 1
hr turnaround. Full availability of all tests on Vitros analysers and
Trop T. Gases with Na/K in A&E and also Bayer FBC. Bleep labs after
midnight just in case they have nodded off.
A&E staff wanted POCT and were the main driver to develop the IDEA
project (Ideal Design of Emergency Access) here. They have funding for
capital but not revenue. There is also the threat of loosing 3* status
if cannot meet waiting times. The A&E consultant who leads this based it
on the ? BMJ publication some years ago from Bristol on the Istats. As
yet we have not purchased the iStat or Stratus equipment.

Problems of the traditional current system are part user:
1. samples "disappear" from A&E - A&E loose control
2 they do not know when the results are ready - we don't inform them
automatically eg phone or bulletin board
3. they have to "search" the hospitals computer database for results,
can be slow.
4. No urea or creatinine on blood gas analyser
5. No user ID or lablink on Bayer FBC analyser - poor for POCT

and part lab workload during busy periods of the day:
1. Many other samples get "priority" so that we reach saturation in the
main lab around the combined Biochem/Haem reception and do not always
meet 1 hr target.
2. There are so many samples from elsewhere arriving by the air tube
that we may miss the A&E samples and other urgent requests at peak
times.

The lab IT staff were loathe to put printers in non lab areas such as
A&E because of the problems of ownership and who would sort out problems
such as lack of paper. Thus reports have to be looked for on terminals
around the hospital

As we were not ready to start this POCT project before the  A&E waiting
times audit last month we started to use another colour for the air tube
pods from A&E plus set one lab MLA the prime function to fast track the
A&E samples in the lab, ensuring that they were dealt with and results
produced. Results were excellent.

We are now getting the EDAs to book in the requests to Telepath in A&E
and send the bar coded samples directly to each lab via the coloured air
tube pod. There is now a printer in A&E for the EDA to receive reports
and put in the patients file. Will it avoid the need for the POCT
project ?

It has taken me months to get people to understand that the best place
for Tropanin, if not the lab, is in the soon to be created Rapid Access
Chest Pain Unit to which the appropriate A&E patients would be sent
(discharged) after the inital triage. Apart from Chest Pain - Cardiac
there were 3 others of the 10 triage categories that would also get
Tropanin tests eg Palpitations, Confusion > 60 yrs, Collapse/Faint > 60
yrs.

EDAs here are MTOs trained in phlebotomy, cannulation, ecgs and lab
tests. With correct training they should be competent to use the limited
range of equipment if we finally use that approach. Naturally some lab
staff have expressed concern. Reduction in the number of A&E samples
reaching the lab could offset time supporting POCT. We already have a
team supporting a wide range of POCT equipment on site. My main concern
was that the EDAs would not have sufficient time for all the testing. We
have 4 EDAs covering the peak A&E period 10am to 10pm each day, but that
means only 1 -  2 at any given time depending on rotas, holidays and
sickness.

The St Thomas' hospital approach is an A&E mini lab using smaller
versions of equipment in the main labs and operated by a qualified BMS.
It is a far cheaper option than POCT even after allowing the extra cost
of 2 BMS staff. Potentially the mini lab is slower as samples have to be
centrifuged but it offers a wide range of tests to good standards at
relatively low cost.


Dr Paul H Eldridge
Clinical Biochemist
University Hospital Lewisham
London SE13 6LH
UK
Phone: (44) 020 8333 3255
Fax:      (44) 020 8690 8891


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