I think what is important here is to separate out the real clinical
emergency from the "It's urgent because I say so" sort.
Yesterday we had a request from ITU for an urgent TSH, clinical details
"Patient slow to wake up" The TSH turned out to be normal and when it
was telephoned to ITU, we were told that the patient had been discharged
to another hospital.
I do appreciate the problems faced by A&E consultants who are looking
for a helpful response from the laboratory, especially when faced with a
problematic patient. I also have concerns that if we offer every test
under the sun on demand, without making attempts to educate our users,
we will become even more of a factory service than we are already.
In general, I have found that the majority of such urgent requests are
unjustified and that therapeutic intervention has been started without
the test result being known. I also find that it helps to explain that
even in the days of analysers being able to produce many hormone results
off the one sample, there is still an appreciable amount of time
required (especially in the middle of the night) before a result can be
produced, as the analyser has to be switched on and set running before
analysis commences.
--
Dr D G Williams FRCPath
Department of Biochemistry
Sunderland Royal Hospital
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