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Helen, Couldn't agree more on your last point. For historical reasons (eg SMAC profiles that ran all tests available whether requested or not), and ease of communication in the paper requesting era, doctors and laboratories have become conditioned to use profiles most of the time. In many cases there is no need clinical for them. For example, we do loads of LFTs (in this Trust ALP, ALT, bilirubin, GGT, albumin) monitoring commonly prescribed drugs according to guidelines or "best practice", when in most of these cases only the transaminase is needed or acted upon. For follow-up of paracetamol OD, only ALT and creatinine are required from the Biochemistry Laboratory but I bet almost all of us respond to this clinical situation with repeated estimations of U&E and LFT (ie. about 5 x as many investigations as actually needed). The testing needed depends on the clinical situation, and we should be encouraging the requesters to define the questions they want answering before making any request. With improved IT we should be able to accommodate clinically-based requesting, and not setting outdated shorthand profiles in tablets of stone. We are starting to try to do this with the fledgling Ordercomms software recently introduced into this Trust. There is of course still a need for a standardised response to the question "I think this patient may have liver disease, can the laboratory help me decide?" but this response should include prothrombin time even if it is usually done by our arch-enemies in the Haematology Lab! Best wishes Angela Mrs Angela Woods Consultant Biochemist East & North Herts NHS Trust ---- Original message ---- >Date: Fri, 11 May 2007 17:53:08 +0100 >From: "Grimes, Helen, UCHG" <[log in to unmask]> >Subject: Re: Basic Test Profiles - >To: [log in to unmask] > >We do need to standardise on basic constituents of a profile. At least we should agree what has to be there, but leave allowance for the individual laboratory to give more. If a GP requests Liver or Lipid Profile from 5 hospital laboratories, there should at least be a common core, not 5 different combinations. Part of the need to have profiles has come from a need to reduce time in test ordering, and reduce time in test requesting inputting, for some it is all the one. It also helped to reduce "add on tests" which can be very demanding on resources, and it seems unethical to me to request further phlebotomy on a patient when there is an adequate sample in the laboratory. It seems we also need an Admission profile, which would be a broader sweep of tests, the ICU profile and the Oncology profile. i.e. tailor made for those specific sections. Maybe we need Initial Diagnostic liver profile, monitoring therapy liver profile etc >Helen >------------------------------------------------------------------------------------------ > > ********************************************************************** This message may contain confidential and privileged information. If you are not the intended recipient please accept our apologies. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Please inform us that this message has gone astray before deleting it. Thank you for your co-operation. NHSmail is used daily by over 100,000 staff in the NHS. Over a million messages are sent every day by the system. To find out why more and more NHS personnel are switching to this NHS Connecting for Health system please visit www.connectingforhealth.nhs.uk/nhsmail ********************************************************************** ------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/