Our Diabetic Day Care Centre sends a letter to patients about a month before
they are due for their annual review clinic.  The patients can take this
either to their own GP surgery or to the phlebotomist in our out-patients
department.  The letter lists the assays which are required and should act
as a request form.

It doesn't always work - we get boric acid containers for the microalbumins
which we knock back.  Also the surgeries don't always use the letter as a
request form but write out fresh forms, but with their surgery as the
address for the report.

On Monday afternoons the secy in the diabetes centre FAXes a list to the lab
of patients for whom she has no lab results.  We print off copies of
anything that the GPs or other hospital departments have requested recently
and she picks up the reports around coffee time the following morning.  This
latter stage in the process should be avoidable soon with the roll out of
web-browser which should allow the diabetes centre staff access to both
hospital and GP results.

The vast majority of the patients have results in the diabetes centre's
computer system by the time they are seen for their annual review.

Elliott

-----Original Message-----
From: Mohammad Al-Jubouri [mailto:[log in to unmask]]
Sent: 26 May 2004 10:28
To: [log in to unmask]
Subject: Re: Assays for patients with diabetes


The most rational solution is to centralise laboratory service provision and
for blood samples to be sent to the lab 2-3 days prior to clinic
appointment. Unfortunately this rational solution is politically
unacceptable as it is against "the one stop shop concept" that is infesting
the NHS. So we end up with DCA analysers in diabetic clinics and GP
surgeries and an HPLC analysers in the laboratories, producing inevitably
inconsistent results. Centralisation of clinical services at least in
secondary care and utilising an efficient air tube system is another
rational approach, if there is the political will to do it.

regards

Mohammad


Jonathan Kay <[log in to unmask]> wrote:

Here's the problem:

1 We want very high consistency in glycated haemoglobin analysis across
the patch: primary, secondary and tertiary care.

2 We are considering assaying glycated haemoglobin, total and HDL
cholesterol, triglycerides and creatinine during the clinic visit for
patients with diabetes. This could be at three sites,

3 Capital and revenue costs need to be as low as possible

4 Relentless increase in requests for glycated haemoglobin analysis
from primary care

Because of 1 my first thought was "laboratory-type" analysers for
glycated haemoglobin on trolleys which could be used in the laboratory
and wheeled down and used PoCT in the clinics. This would give high
consistency and low cost but won't give the extended repertoire.

Air tubes + in-laboratory analysis alone won't solve the problem
because one ! site doesn't have an on-site laboratory and another doesn't
have enough air tubes.

Will we inevitably end up with different methods used in the laboratory
and clinic?

I have a feeling we are not alone in having this problem. Does any one
have good solutions they could share?

Thanks

Jonathan

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Dr. M A Al-Jubouri
Consultant Chemical Pathologist



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