but its not designed to affect a decision to
thrombolyse Rowley as u wel no. Thats like saying my
car cost loads of money to run, I'm going to ditch it
cos I'm a vegetarian. It is tirofiban that is given on
the basis of a raised TnT or TNI. Do you not use it?
Maybe you mean that you can get patients admitted
quickly and rely on the medical team knowing how and
when to use it - I should be so lucky
Steve Meek
North Bristol EDs
--- Rowley Cottingham
<[log in to unmask]> wrote:
> I have just discovered our Trop-T machine has cost
> us £16k this year.
> Bearing in mind how rarely a positive Trop-T affects
> a fast track
> decision to thrombolyse (i.e. it doesn't) I propose
> to give it the bird.
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of
> [log in to unmask]
> Sent: 12 March 2003 11:22
> To: [log in to unmask]
> Subject: Re: near patient testing
>
>
> 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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