This interesting thread seems to have turned into
a POCT discussion -
I have just picked it up late after a spell away.
I agree with David Alter that the need (or not) for
POCT should be
decided in terms of clinical untility before it is implemented. Reduced
TAT isn't necessarily the only consideration either (see Kendall et al
BMJ 1998;316:1052-1057)
Both David Brown and Ian Barlow make
valid points - unfortunately it is
still sometimes necessary for the lab to pick up a POCT "almost" fait
accompli and make the best of it (although much less frequently than
in the past), while Ian's advocacy of the lab taking the initiative to
establish a POCT committee is bang on.
I think the reality is that there
will always be clinicians wanting to
bypass the lab and establish POCT, with some companies willing to
market POCT directly to them. The lab has an important
influencing/persuading role and will continue to do so - we have to
accept that and develop it, while remaining pragmatic. We can offer
quality and risk management to clinicians and cost effectiveness to
managers - point this out to them and they do take notice.
> The rule of thumb
for point of care vs the main lab should not be "every
> good ICU has
one" but is the need for a rapid at the patient bedside test
> warranted i.e.
does it have clinical utility when the lab can provide a
> similar result
but with a longer, but not onerous, TAT especially in light
> of the fact that
POC tests cost 10x the cost of the same test done in the
> lab.
> In my opinion,
the utility of the particular POC test in relation to its
> intended use
need to be justified along those lines, i.e. where a rapid
> bedside result
is going to have more of a clinical impact than waiting for
> the result from
the lab when a STAT request is unfeasible.
> David Alter,
MD
________________________________________________
Dr MJ Pearson
Department of Clinical
Biochemistry & Immunology
Old Medical School
Leeds General Infirmary
(Leeds Teaching Hospitals NHS Trust)
LEEDS LS1 3EX
Tel 0113 392 3945
Fax 0113 233 5672
http://www.leedsteachinghospitals.com
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