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Dear all Our ward order comms system (Torex) alerts clinicians that a particular test has already been requested within the last x days, and gives them the opportunity to either retest or not. The saving in repeats goes someway to funding the implementation of the system in the first place. Aside from the ethical considerations mentioned by Jonathan about who is asking for the demand to be managed, with Payment by Results around the corner there may actually be a disincentive to try and reduce workload. Indeed, the next buzzphrase could become 'demand enhancement' from a laboratory perspective! Eric Dr. Eric S. Kilpatrick Consultant in Chemical Pathology Department of Clinical Biochemistry Hull Royal Infirmary Anlaby Road Hull HU3 2JZ Tel 01482-607708 Fax 01482-607752 >From: Jonathan Kay <[log in to unmask]> >Reply-To: Jonathan Kay <[log in to unmask]> >To: [log in to unmask] >Subject: Re: Demand management >Date: Thu, 28 Apr 2005 20:29:19 +0100 > >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 > >------ACB discussion List Information-------- >This is an open discussion list for the academic and clinical >community working in clinical biochemistry. >Please note, archived messages are public and can be viewed >via the internet. Views expressed are those of the individual and >they are responsible for all message content. > >ACB Web Site >http://www.acb.org.uk >List Archives >http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html >List Instructions (How to leave etc.) >http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/