Jonathan

I agree that the best option is a clinican buy-in to interactive requesting, and this highlights for me the fact that laboratory requesting should be an EPR function rather than a laboratory computer function, so that it is fully interactive with the knowledge base of the EPR, but also must be compliant with the laboratory professionals' view.

 

However until we reach Nirvanah, it seems reasonable to have some scientifically based repeat order times in order to protect the patient from unnecessary repeat testing (which might also be considered 'assault') and our budgets.  These days we all keep our samples for a limited period, and I certainly can be persuaded by clinical colleagues to over-rule the rules, but I have had no significant complaint in the several years of operation. I understand that one London teaching hospital (second hand evidence so no names in public) saw a dramatic decrease in repeat requesting on introduction of interactive ward-based requesting.

 

I have considerable experience with 'repeat order times' which are available within iSoft APEX if it is of use.

We currently use these extensively, but I don't collect detailed data, we just use it on the understanding that we are cutting down !

Currently, with no link at all to PAS data and no ward-based requesting, our practice is that the request entry staff decline 'flagged' requests which are put aside for senior assessment.  Refused tests are always added to the report with an 'educative' comment, for example "Normal red cell half life is 60 days, hence repeat HbA1c within 3 months is not helpful." I am prepared to share with interested parties the time factors which we have built in for each investigation.

-----Original Message-----
From: Jonathan Kay [mailto:[log in to unmask]]
Sent: 28 April 2005 20:29
To: [log in to unmask]
Subject: Re: Demand management

 

Who is asking you to "manage demand"? Managers, clinicians or patients?

 

There are major ethical issues with "rejecting" requests once the specimen has been collected. I don't like shroud waving but in the worst case it could be assault.

 

Guidelines defining "inappropriate" requests need to be owned by, and not merely acquiesced in, by clinicians. I don't think it's appropriate to have such plans without the clinicians in the loop.

 

All this is likely to be a lot more acceptable the more upstream in the request-report cycle you implement it. It's better to reject at the point of the request being made than when the request hits the laboratory. It's even better if it's implemented when the clinician is seeing the patient and agreeing the plan.

 

Condition-based rather than analyte-based requesting ought to help.

 

Does anyone have opinions or even experience on whether clinical budgetting has a major effect on this?

 

Jonathan

On 28 Apr 2005, at 20:02, AVADES Tony wrote:

 

Dear Colleagues,

 

 

 

As part of our approach to manage the demand, we are introducing several measures; one of them is to cut down on the number of inappropriately and frequently requested tests. In accord with others, we have shown by local audits that tests like TFT, HbA1c, Vit B12 and folate are requested more frequently than they should.

 

 

 

Does anyone have experience of devising lab systems that could block frequent requesting?

 

 

 

I understand that with some LIS like Pathnet, you could set certain roles to block requests, but I am not aware of this approach with other LIS such as Telepath.

 

 

 

Furthermore is this approach ethically accepted, and would blood sample that was taken from a patient and later refused to be analysed by the lab, considered to be a clinical incident.

 

 

 

I would be grateful if colleagues could share their experience and I am willing to share our approaches and plans here in Cardiff to manage the demand.

 

 

 

With best wishes

 

Tony