Hi Chris:-
‘hence freeing up a bed.’
was mentioned by one respondent (that was me). I think the requirement for 24/7 analysis is generally towards discharge home than to transfer to a tertiary referral centre.
Transfers take place during the evenings and weekends therefore the test should be done – and the bed freed up and the patient managed in a timely manner. If I had a possible SAH I would be slighlty niffed if my management
was being affected because of the local labs inability or unwillingness to provide this important test for me.
Obviously timely analysis and result reporting is our aim, but also consider the following (and is with respect to those performing spectrophotometry) :
1.
The additional stress placed upon the reduced levels of BMS staff OoH to perform the test.
If the test is really needed and the management of the patient is directly dependent on that test, then we should perform it. This is no excuse – we simply must manage this scenario as laboratory professionals. There
are lots of ways to address what you say.
2.
The spectrophotometer is often (in my experience) NOT located in the core lab but within a specialist lab area requiring going to a different area of the building to perform the test, thus taking a member of staff
from the core lab (re: staffing levels, answering phone, singlehandedly trying to fix your core analysers to stop the phone calls for delayed results).
Then why not move the equipment to where it can be used efficiently?
3.
Who finally reports the result, which can be less than straight forward on many occasions, requiring application of additional data and liaison with clinicians to verify details not always included in the request,
e.g., timing of LP in relation to onset. Most are negative – so they are easy.
However, for difficult cases our staff scan the spec results – so I can review at home, interpret and then discuss with the medics – 24/7. After all – this is my job.
4.
Who double checks that the automatic software has reported correctly and the result further transcribed in the LIMS and reported correctly, and appropriate caveats to the report explained to the requesting team,
e.g., samples not received protected from light risk of degradation of bilirubin and thus reporting a FALSE NEGATIVE.
Our BMS staff are highly trained – and have demonstrated their competency, so they are very capable of at least basic interpretation.
We add automated caveats to all report along those lines and I interpret the complex ones as above.
5.
I’m sure our colleagues at the EQA scheme could provide some data as to the number of poor, misleading or simply wrong results reported.
‘The cost
of missing an SAH can cost the Trust MILLIONS if missed,’
but also the cost of mis-reporting a +ve and sending a patient for an invasive procedure which carries a small but definite risk of morbidity and mortality is also
quite costly. (This is ALWAYS a risk and has happened I understand
The bottom line is – we are a service industry and are there for the benefit of our patients. We are highly skilled people
and work in multi million pound laboratories and therefore we should use our expensive equipment and apply our knowledge for the benefit of patients 24/7. We should not use excuses NOT to provide a service but instead manage what we do and be innovative so
that we CAN be responsive and effective – but at the same time provide a reliable and safe service.
Regards
Ian
From: Clinical
biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of
Reeves Christopher (RW3) CMFT Manchester
Sent: 15 November 2012 11:17
To: [log in to unmask]
Subject: Re: Xanthochromia
Do patients get transferred OoHs and if so do they get Angiography OoHs?
‘hence freeing up a bed.’
was mentioned by one respondent. I think the requirement for 24/7 analysis is generally towards discharge home than to transfer to a tertiary referral centre.
Obviously timely analysis and result reporting is our aim, but also consider the following (and is with respect to those performing spectrophotometry) :
6.
The additional stress placed upon the reduced levels of BMS staff OoH to perform the test
7.
The spectrophotometer is often (in my experience) NOT located in the core lab but within a specialist lab area requiring going to a different area of the building to perform the test, thus taking a member of staff
from the core lab (re: staffing levels, answering phone, singlehandedly trying to fix your core analysers to stop the phone calls for delayed results)
8.
Who finally reports the result, which can be less than straight forward on many occasions, requiring application of additional data and liaison with clinicians to verify details not always included in the request,
e.g., timing of LP in relation to onset.
9.
Who double checks that the automatic software has reported correctly and the result further transcribed in the LIMS and reported correctly, and appropriate caveats to the report explained to the requesting team,
e.g., samples not received protected from light risk of degradation of bilirubin and thus reporting a FALSE NEGATIVE.
10.
I’m sure our colleagues at the EQA scheme could provide some data as to the number of poor, misleading or simply wrong results reported.
‘The
cost of missing an SAH can cost the Trust MILLIONS if missed,’
but also the cost of mis-reporting a +ve and sending a patient for an invasive procedure which carries a small but definite risk of morbidity and mortality is also quite
costly. (This is ALWAYS a risk and has happened I understand)
If the answer to my first question is No, then is this a risk worth taking?
Chris
Chris Reeves
Principal Clinical Biochemist
Dept of Clinical Biochemistry
Central Manchester University Hospitals NHS Foundation Trust
Tel: 0161 701 1206
Internal: 11206
www.cmft.nhs.uk Central Manchester University Hospitals NHS Foundation Trust includes:
Hospital, Saint Mary's Hospital,
and Community Services.
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:
Sent: 15 November 2012 10:03
To:
Subject: Re: Xanthochromia
I agree, missing an treatable SAH can be catastrophic for the patient,
their family and society.
The national audit (done quite a few years ago, Ann Clin Biochem 2007 44
443-448) showed that about half the labs were offering a 24/7 service.
These were often hospitals that referred patients to a neurology unit in
another hospital and so, as Ian Barlow says, they can be transferred and
have their further investigations in neurology. Those hospitals who do
not need to transfer their patients probably feel that 24/7 service is
not so necessary.
Kind regards
Ian
Ian Holbrook
Department of Clinical Biochemistry
YO31 8HE
01904 725786
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:
Sent: 14 November 2012 18:16
Subject: Re: Xanthochromia
So, a low risk (CT negative) patient appears to have a ~1% chance of
SAH. Multiply this by a potential lawsuit of millions, not to mention
being eviscerated in the Daily Mail for not offering a "simple and cheap
test, which could have prevented this tragedy" (their imagined words). I
don't like those odds.
On the other hand, the argument for not offering a 24/7 service would be
what? (And "next morning" might be fine for most of the year, but could
be four days if it's a bank holiday weekend.)
Regards
Paul
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