The possibility of preventing unnecessary tetss is cited. This is an old
chestnut that does not take into account the fact that a test may seem
unnecessary in the light of day with the benefit of hindsight but in many
cases, e.g. the SHO potassium at 3am, there is a good reason for carrying it
out [peace of mind becausze a normal potassium means the odd ECG can be
ignored and he can get some sleep]. It is VERY difficult to define
unnecessary - we tried in a project here a few years ago and gave up because
our viewpoint was so different from those making the request.
TIM
****************************************************************************
*********
Prof. Tim Reynolds,
Clinical Chemistry Department,
Queens Hospital,
Belvedere Rd.,
Burton-on-Trent,
STAFFORDSHIRE,
DE13 0RB,
UK.
tel: 01283 511511 ext. 4035
fax: 01283 593064
email: [log in to unmask]
alternative email for the all too frequent occasions when the NHS email
connection doesn't work:
[log in to unmask]
****************************************************************************
**********
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> -----Original Message-----
> From: Peter Cudd [mailto:[log in to unmask]]
> Sent: 17 January 2003 15:22
> To: [log in to unmask]
> Subject: Re: Mass production of tests
>
>
> I take your point that guidelines can be abused by management,
> and that the sheer quantity of information is a problem. But
> is that an
> argument for allowing chaos(where it exists)and ever increasing demand
> to continue unchecked? The introduction of IT should aid the
> medical teams
> to do their job. That includes using the most up to date information
> available on best practise. If the IT systems/guidelines
> being used don't
> reflect and support the actual practise of medical teams then
> obviously
> something is at fault somewhere and one of the possibilities is that
> the medical teams are guilty of not following best practise. (Other
> possibilities obviously exist, e.g. medical teams not having
> the resources
> to follow the guidelines, management somehow preventing change in
> guidelines to meet the needs of the medical teams, etc.)
>
> It is already the case that nurses work to protocols and there is an
> assumption that they will work to protocols in the future(whether
> implicit or explicit). Indeed in many cases Nurse practioners do refer
> to a documented protocol to decide their pathology requests
> on a day by
> day or even case by case basis. At least in one busy area in
> the hospital
> medical teams are successfully coping with detailed
> documented protocols/
> guidelines, regular updates, liaison etc. - so its not so
> impossible. Also,
> in the A&E department they have up to 300 hypertext
> guidelines available
> to medical staff (primarily intended for junior doctors)
> which cover most
> aspects of 'how to deal with a particular presentation of medical
> conditions'these are referred to only when guidance is required, but
> nevertheless are readily available. Nearly all the nurses I have
> interviewed appreciate and want better/more information to work from.
>
> Most, if not all, pathology departments must be faced with
> the fact that
> there are unnecessary requests for investigations and that
> they can only
> get to the required information to identify some of them. Nurses and
> Consultants I have interviewed almost universally agree that there is
> considerable unnecessary requesting of pathology investigations. Many
> believe this is primarily driven by Clinical Governance issues. I have
> yet to determine if the junior doctors are the guilty parties or scape
> goats.
>
> Peter
> Pathology Workload Officer
>
>
> On Fri, 17 Jan 2003 12:01:57 -0000, Reynolds Tim (RJF) Burtonh-tr
> <[log in to unmask]> wrote:
>
> >One interpretation of the trend towards guidelines is that
> they are not
> >there for the benefit of staff to ensure that they know the correct
> >procedure: Management knows that there is no way any one
> individual could
> >read, digest, understand and remember all of the policies
> and guidelines in
> >place at any one time (millions of pages, given that
> computers now allow us
> >to be as verbose as we like, without wasting any real
> trees); let alone
> keep
> >up with changes. Furthermore it would be impossible to check
> the guideline
> >every time a procedure is carried out.
> >
> >The real function of guideleines is to allow an individual
> transgressor to
> >be blamed when an error occurs, thus off-setting the
> institution's blame on
> >an unwitting scapegoat.
> >
> >
> >TIM
> >
> >*************************************************************
> **************
> *
> >*********
> >Prof. Tim Reynolds,
> >Clinical Chemistry Department,
> >Queens Hospital,
> >Belvedere Rd.,
> >Burton-on-Trent,
> >STAFFORDSHIRE,
> >DE13 0RB,
> >UK.
> >tel: 01283 511511 ext. 4035
> >fax: 01283 593064
> >email: [log in to unmask]
> >alternative email for the all too frequent occasions when
> the NHS email
> >connection doesn't work:
> >[log in to unmask]
> >
> >*************************************************************
> **************
> *
>
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