Mike,
Why not also do cardiac enzymes? After all most women do not have classic
symptoms and many elderly and diabetic patients do not fall into the
crushing chest pain presentation. About 60% of patients coming to our ED
with ACS do not have classic symptoms. I do agree in groups of tests for
different sets of symptoms but I want it to reflect a policy developed by
the ED, the lab and the appropriate specialist physicians not by someone who
is not seeing the patient and happens on the results.
I also think rebleeding the patient when a good sample is in the lab is
tantumount to an assault on the patient.
ELizabeth
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of Mike Collins
Sent: April 21, 2004 12:35 PM
To: [log in to unmask]
Subject: Re: Assaulting patients with added tests
Craig
Here's a different A&E scenario.
Patient has abdo pain.
U&E glucose sent to lab.
1 - 2 hours later cas ring up to ask why no amylase result on the server.
Sample recovered and amylase added. 1 to 5 hours after that a ward rings up
to ask for the LFT result. Sample dug out again and LFT added. Alternatively
with a no add-ons policy the patient has been bled twice more.
How much simpler and cheaper to do U&E, LFT amylase on every abdo pain.
Mike Collins
--
Mike Collins
BMS3
Clinical Biochemistry & Immunology
Leeds Infirmary, Old Medical School
Thoresby Place, Leeds LS1 3EX
UK
44 (0) 113 392 2915
[log in to unmask]
NB I will be leaving on April 23rd 2004
Emails about clinical trials should go to;
[log in to unmask] and
[log in to unmask]
>>> Craig Webster <[log in to unmask]> 21/04/2004 17:08:55 >>>
The not doing of tests comes down to whether you are consulting an
expert in the laboratory or just ordering a test. If we take the example
of tumour markers, one of the most popular requests from A&E at the
moment goes along the lines of: Stomach pain ? Cause with U&E, Ca, LFT,
Thyroid Function tests, CEA, CA125 (if female), CA199, CA153, PSA, AFP &
HCG should we just do this because its been ordered or actually think
about the finite resources the NHS has and actually try and direct
appropriate investigations?
I'm interested because it does seem from some of the arguments that the
lab should be a black box and just do what we are told.
Regards
Craig
Craig Webster
Principal Clinical Biochemist
Nottingham City Hospital
-----Original Message-----
From: owner-acb-clin-chem-gen [mailto:owner-acb-clin-chem-gen]
Sent: Wednesday, April 21, 2004 3:17 PM
To: cwebste1
Subject: Re: Assaulting patients with added tests
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