I suppose it depends on the kit Goat. Our ABG machine is dead easy; any time spent feeding the machine is offset by not having to fill forms in/label samples/feed the vacuum shute etc. Our troponin is a bit slow, but you normally do something else while you're waiting for the 12 minutes to brew, well, I assume the SHOs do something else rather than watch the machine for 12 minutes! I don't have experience of other machines, but I agree they'd only be viable if real easy to use.
Adrian
> from: Goat <[log in to unmask]>
> date: Wed, 12 Mar 2003 07:48:18
> to: [log in to unmask]
> subject: Re: near patient testing
>
> Do the cost-benefit equations include the cost of ED staff time in doing
> the tests?
> I have always been suspicious of any change in working practice that
> dumps more jobs on clinical staff that can, and should be done by non-
> clinical staff.
> Time-critical stuff (gases, BM, ?troponins, K ), fine. But not the rest.
> I had some experience as an SHO in an ED with a gadget which did
> amylase, U E, Hb, CK etc. The labs closed their weekend service and
> PRHOs / staff nurses spent their life doing tests that were perhaps not
> urgent, but couldn't wait until Monday. Waiting times went through the
> roof and the labs quickly re-openend their OOH service.
> Modern thin film technology for NPT is quicker and more reliable, but I
> still reckon the lab staff should be doing the tests (if needs be in the
> ED), rather than put another time demand on front-line clinical staff.
>
> Goat
>
>
> In article <[log in to unmask]>, Jason Kendall
> <[log in to unmask]> writes
> >Near Patient Testing is NOT the complete solution to faster treatment /
> >disposition decisions / transit times / improved outcome, etc. It may, however,
> >have a definite role in certain situations.
> >
> >If NPT of a "critical care profile" (biochem, haematology and ABGs) is applied
> >to an unselected population of emergency department patients (i.e. all those
> >that require an urgent blood test), it will not make a significant difference in
> >terms of transit time or clinical outcome (mortality or length of hospital stay)
> >to the group as a whole in a typical UK ED. This is because there are generally
> >many other important factors that need to also be addressed (absence of
> >in-patient beds, access to radiology, etc). It does not even appear to expedite
> >discharge, where factors such as organising transport, social arrangements...
> >seem to outweigh any benefits of NPT.
> >
> >NPT does improve processes of care by significantly improving turnaround time
> >and expediting therapeutic decision making. This benefit seems to get lost,
> >however, when trying to translate this into measurable improvements in outcome
> >in the population as a whole. There may be benefit in certain selected
> >sub-groups of patients (we all appreciate the benefit of NPT for glucose, for
> >example, although this is clearly already well established). The problem is that
> >this technology is expensive (see below) and is most likely to be used fairly
> >indiscriminately whenever results are required "urgently".
> >
> >It is definitely NOT cost-effective if implemented piecemeal within a trust
> >(i.e. just in the ED, for example). There will be no savings in fixed costs
> >within the central laboratory, and the overall effect is to make testing
> >everywhere else in the hospital more expensive. If there is the motivation and
> >political will (amongst the pathologists!) to completely change testing within
> >the hospital more widely, implementing NPT in the ED, MAU, CCU, ITU, theatres...
> >then there is a definite economic argument for this, since fixed costs in the
> >central lab can be reduced (i.e. sacking technicians).
> >
> >The above arguments are very generic, and local factors are very important. If
> >your central lab service is very poor, you don't have resident MLSO's, need to
> >stick samples in taxis... then any of these factors will increase the case for
> >NPT, because they will influence the clinical or economic issues.
> >
> >Specific conditions, such as NPT for chest pain will depend critically on the
> >service that you get from your lab. We get access to 24 hour urgent troponins
> >from our lab, and it is likely that the time saved in turnaround with NPT (of
> >the order of 60 mins) would not outweigh the economics of NPT, particularly
> >since the decisions made based upon troponins are not immediately "time
> >critical" - i.e. discharge decisions for rule-out, and commencement of Gp
> >IIB/IIIA for rule-in. If your lab offers a poor service by batching troponins,
> >however, then there is a powerful argument for NPT, because the potential for
> >time savings and admission prevention is huge.
> >
> >Jason Kendall.
>
> Dr G Ray
> A&E
> Sussex
> Reply to [log in to unmask]
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