 |
 |
Yes, Jan, you're right about possible cost inflation. Unless a protocol for appropriate use of the i-STAT is agreed at the start and the person (preferably someone with a frightening manner) supervising the system on site ensures that this is followed and access is strictly controlled, half the world will turn up with an urgent need to use it at every opportunity. So far, our sites are fairly self-contained and this hasn't happened, but perhaps an ITU would be different. Software updates so far have been OK, but I can see potential problems there. Dr MJ Pearson Department of Clinical Biochemistry & Immunology Old Medical School Leeds General Infirmary (Leeds Teaching Hospitals NHS Trust) LEEDS LS1 3EX UK tel (44)-113-392-3945 fax (44)-113 392-3453. http://www.leedsth.nhs.uk >>> Janice Still <[log in to unmask]> 06/24/06 12:39 PM >>> I agree with Joan to a certain extent. We had i-Stat in our ITU as they came as part of the Hewlett Packard patient monitoring systems that were installed.We found them difficult to manage effectively and particularly costs ran away.The unit was using several different cartridges for differing needs, and it rapidly became clear that if the staff needed a straight blood gas cartridge, but there were none ready from the fridge,(a frequent occurrence) then they would use an all-singing gases, electrolytes, glucose,lactate, cartridge at twice the price.The software updates every three months were a NIGHTMARE.As hand held devices they were also horribly easy to lose. After the first year the staff had no confidence in the system as we were getting a lot of potassium flyers and the staff simply did not believe any of the results. Costs were twice the budget. We removed the system and went to a cartridge blood gas analyser from IL and have had no problems. They are extremely useful in ambulances, air ambulances and other community uses, but I am not convinced of their usefulness in an acute/critical care setting over a well chosen and tested blood gas analyser. Jan Still, Point of Care Testing Manager, West Herts Hospitals. --- Joan Pearson <[log in to unmask]> wrote: > Shirley - I've recommended the i-STAT for 3 sites > here so far (Cystic > Fibrosis unit, orthopaedic OTs - both at remote > sites, and some OTs just > near our main site here) although these are not > strictly speaking > critical care. Our 9 ITUs, main OTs, several HDUs > and 2 A&Es have blood > gas analysers. There re 2 main reasons for > recommending i-STAT: > > - areas requiring short TAT, but with low test > numbers, and/or sporadic > testing rather than constant throughput, > - staff shortages, meaning that we can't take on any > more POCT blood > gas analyser support. > > The i-STAT has a good track record analytically if > used correctly, but > high cost per test, which matters with high test > numbers (if low or > sporadic, then costs compare favourably with a blood > gas analyser with > constant throughput of calibrant/wash > solns/electrode/membrane > replacements or time-limted cartridges). > > The users are happy with the anaytical performance, > but mostly unhappy > with the "management" they have to do (apart from > the CF unit where a > superb senior physio runs an excellent system) - > stock control/ordering, > thinking ahead to take cartridges out of the fridge > before use, keeping > track of in-date stock. You have to insist that a > named person on site > takes responsibility for supervision of all that and > you have to > organise them re training and QC/EQA and keeping > proper records because > they won't do it otherwise. I think this is > generally the case with > POCT - they love it if someone else (ie lab staff) > do all the > maintenance etc., but never realise how much is > necessary if we don't. > > Dr MJ Pearson > Department of Clinical Biochemistry & Immunology > Old Medical School > Leeds General Infirmary (Leeds Teaching Hospitals > NHS Trust) > LEEDS LS1 3EX > UK > > tel (44)-113-392-3945 > fax (44)-113 392-3453. > > http://www.leedsth.nhs.uk > > > >>> Shirley Spoors <[log in to unmask]> > 23/06/2006 12:02:29 >>> > Dear All > > We are considering introducing the portable, > hand-held i-Stat system > onto Critical Care (and perhaps the emergency > department) but we do > not > have any experience in the use of this bed-side > technology. > > Does anyone have this system in place and would like > to share his/her > experience with us? > > Many thanks > > Shirley > Dr Shirley Spoors > Consultant Biochemist > Department of Clinical Biochemistry > Doncaster and Bassetlaw Hospitals NHS Foundation > Trust > > ------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/ > Mrs. J. Still, POCT Manager, Biochemistry Dept, Watford General Hospital. 01923-217998. The views expressed in this message are personal and do not reflect West Herts NHS Hospitals Trust policy. ___________________________________________________________ To help you stay safe and secure online, we've developed the all new Yahoo! Security Centre. http://uk.security.yahoo.com ------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/