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Our lab system (ISS Omnilab) has a "critical care" module which was originally intended to feed results to monitors by the patient bedside. It has been modified so you can put a client on a PC (driving an appropriately located big screen TV as the monitor) and log in as a particular location. The screen will display all patients on the logged in location who have requests on the system. Patients with new un-acknowledged results appear at the top of the list in red. Each patient is effectively a hyperlink to the associated results so you just click on a red patient ID to review a cumulative display of the most recent results. Once the results have been reviewed the patient either goes off the list if everything has been viewed or goes down the list to appear in black if there are still results pending. Sounds like it does the job? Well yes and no - * First modification was to get rid of Microbiology, > 1/2 day turnaround Biochem & Haematology etc off the screen as the display was swamped with "old, non-acute" results. * 2nd modification would ideally be to display results according to the current location of the patient rather than location at the time of requesting. That has proved impossible as the absence of ward clerks means the PAS does not feed patient moves in real time hence we cannot update ICE order comms or the lab system with the real location. That means the clinicians don't get alerted when a result appears for a new patient (eg requested in A&E but patient is now on the acute admission unit) so the display is not offering as good a service as it might. May be better soon as we are implementing an RFID tracking system which might be able to provide current location of patients in close to real time. * It proved too intense for our acute admission units where you would think it would work at it's best and save the most doctor time. We showed them how it should be operated and cleared all pending results then left them to it. - The system very soon got ahead of the clinicians as it took too long to review the results and deal with the patients. They stopped trying after about half a day. Despite multiple offers to implement it on somewhat less intense clinical areas there have been no more takers. Richard Stott Principal Clinical Scientist Doncaster & Bassetlaw Hospitals NHS Foundation Trust -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay Sent: 16 December 2015 19:27 To: [log in to unmask] Subject: Re: Telephoning Cardiac Troponin results One of the issues in finding the best processes for this communication is the degree of pushiness that is desirable from the information system. In addition to getting the reports into the patients' records it's worth considering some sort of rolling presentation with the following being considered: * Orientation by clinical location rather than individual patient identity * Reducing the need to log-in to see if there's anything new that needs to be acted on * Escalation on failure to view (or even failure to act). 'Phone calls are inherently rather pushy as well being very expensive and not making it easy to check what happened. Automated feeds to printers in clinical areas are also rather pushy. Any good description of pushy systems that anyone would like to share that don't have the disadvantages of those two media? Jonathan On 16 Dec 2015, at 18:37, Lou, Amy <[log in to unmask]<mailto:[log in to unmask]>> wrote: > Hi, > > We call troponin T> 50ng/L (the first one within 14 days) to all physicians except for patients from Cardiac units. > > Cheers, > > Amy > Amy Lou, M.D. Ph.D. FCACB > Clinical Biochemist > Division of Clinical Chemistry > Department of Pathology and Laboratory Medicine Nova Scotia Health > Authority Assistant Professor of Pathology, Medicine Dalhousie > University Rm 617 Mackenzie Bldg, QEII Health Science Centre > 5788 University Ave, Halifax, NS. B3H 1V8 > Ph: 902-473-1528 > Fax: 902-473-2123 > Email: [log in to unmask]<mailto:[log in to unmask]> > > -----Original Message----- > From: Clinical biochemistry discussion list > [mailto:[log in to unmask]] On Behalf Of Christine > Collier > Sent: Wednesday, December 16, 2015 2:04 PM > To: [log in to unmask]<mailto:[log in to unmask]> > Subject: Telephoning Cardiac Troponin results > > Hi there, > > We don't have critical values for our troponins. > > However, we have recently been asked by the emergency department to phone troponins over 100 ng/L. One reason was that with crowding the emergency department, physicians are often handling multiple patients, and no longer have a printed result being handed to them by a unit clerk who recognizes the importance of an abnormal troponin. Because no troponin value is "critical," > it does not even result in a red flag on the EDIS computer tracking screen. > Moreover, chest pain patients may be in a hallway, or indeed still in the waiting rooms, when the troponin is resulted, sad but true. > > During the above request, it was mentioned that venous blood gas pO2's of < 35 mmHg were being flagged as critical and thus contributing to the alarm fatigue of red flags/phone calls. So we were able to remove these flags and address this issue. > > As we expect about 5 calls to be needed a day, we are doing a trial of calling Trops > 100 ng/L (the first one on a patient) to the emergency department only over the next few months. > > > Cheers, > Christine > > > C. Collier, PhD FCACB, > Clinical Chemistry, > Kingston General Hospital, > Ontario, Canada > > ------------------------------ Original Message > ------------------------------ > Subject: Re: Telephoning Cardiac Troponin results > From: "Andrew Lyon" <[log in to unmask]<mailto:[log in to unmask]>> > Date: Wed, December 16, 2015 10:05 am > To: [log in to unmask]<mailto:[log in to unmask]> > ---------------------------------------------------------------------- > -------- > > Our laboratories serve a network of three hospitals as well as a large volume of test requests for ambulatory community-based outpatients. > > We do not phone troponin results for patients in the hospitals (e.g. troponin tests are not on our critical test list). > We have a few small number of troponin requests for community-based outpatients. If those troponin results are >50 ng/L, (presumably unexpected !) the results are phoned to the community-based physicians that ordered the test. > > regards, Andrew > > > Dr. A. Lyon > Saskatoon Health Region, > Saskatoon, SK, Canada. > > > ----- Original Message ----- > From: Bosomworth Mike (LEEDS TEACHING HOSPITALS NHS TRUST) > <[log in to unmask]<mailto:[log in to unmask]>> > To: [log in to unmask]<mailto:[log in to unmask]> > Sent: Wed, 16 Dec 2015 03:52:46 -0700 (MST) > Subject: Telephoning Cardiac Troponin results > > Dear All, I am being put under pressure to agree to telephone out all high cardiac troponin (cTn) results. Do other labs do this and if so at what level (please include your diagnostic cut off value for ACS if you do and you respond)? If we were to telephone out all raised TnI results i.e. those > 50 ng/L I calculate that it would take over 2 hours which is clearly not feasible, or at least not with existing resources. Thank you in anticipation of your help. With best wishes for Christmas and the New Year. > > Mike > > Dr Mike Bosomworth > Clinical Service Lead for Blood Sciences and Specialist Laboratory > MedicineConsultant Clinical Biochemist > > ********************************************************************** > ********************************************** > > > This message may contain confidential information. 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Views expressed are those of the individual and they are responsible for all message content. > ACB Web Site > http://www.acb.org.uk > Green Laboratories Work > http://www.laboratorymedicine.nhs.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 > Green Laboratories Work > http://www.laboratorymedicine.nhs.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 Green Laboratories Work http://www.laboratorymedicine.nhs.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/ Travelling to Doncaster Royal Infirmary? Why not use the free Park & Ride service from Doncaster racecourse - free parking with free shuttle buses to and from the hospital every 15 minutes (6.30am-10pm, Mon-Fri). Travelling between our hospitals? Why not use the free shuttle buses between: Bassetlaw Hospital and Doncaster Royal Infirmary Montagu Hospital and Doncaster Royal Infirmary This email is confidential, private and privileged. If you are not the intended recipient please accept our apologies. Do not disclose, copy or distribute information in this email or take any action in reliance on its contents; to do so is strictly prohibited and may be unlawful. Please inform us that this email has gone astray before deleting it. Thank you for your cooperation. ------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 Green Laboratories Work http://www.laboratorymedicine.nhs.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/