Near Patient Testing is NOT the complete solution to faster treatment /
disposition decisions / transit times / improved outcome, etc. It may, however,
have a definite role in certain situations.
If NPT of a "critical care profile" (biochem, haematology and ABGs) is applied
to an unselected population of emergency department patients (i.e. all those
that require an urgent blood test), it will not make a significant difference in
terms of transit time or clinical outcome (mortality or length of hospital stay)
to the group as a whole in a typical UK ED. This is because there are generally
many other important factors that need to also be addressed (absence of
in-patient beds, access to radiology, etc). It does not even appear to expedite
discharge, where factors such as organising transport, social arrangements...
seem to outweigh any benefits of NPT.
NPT does improve processes of care by significantly improving turnaround time
and expediting therapeutic decision making. This benefit seems to get lost,
however, when trying to translate this into measurable improvements in outcome
in the population as a whole. There may be benefit in certain selected
sub-groups of patients (we all appreciate the benefit of NPT for glucose, for
example, although this is clearly already well established). The problem is that
this technology is expensive (see below) and is most likely to be used fairly
indiscriminately whenever results are required "urgently".
It is definitely NOT cost-effective if implemented piecemeal within a trust
(i.e. just in the ED, for example). There will be no savings in fixed costs
within the central laboratory, and the overall effect is to make testing
everywhere else in the hospital more expensive. If there is the motivation and
political will (amongst the pathologists!) to completely change testing within
the hospital more widely, implementing NPT in the ED, MAU, CCU, ITU, theatres...
then there is a definite economic argument for this, since fixed costs in the
central lab can be reduced (i.e. sacking technicians).
The above arguments are very generic, and local factors are very important. If
your central lab service is very poor, you don't have resident MLSO's, need to
stick samples in taxis... then any of these factors will increase the case for
NPT, because they will influence the clinical or economic issues.
Specific conditions, such as NPT for chest pain will depend critically on the
service that you get from your lab. We get access to 24 hour urgent troponins
from our lab, and it is likely that the time saved in turnaround with NPT (of
the order of 60 mins) would not outweigh the economics of NPT, particularly
since the decisions made based upon troponins are not immediately "time
critical" - i.e. discharge decisions for rule-out, and commencement of Gp
IIB/IIIA for rule-in. If your lab offers a poor service by batching troponins,
however, then there is a powerful argument for NPT, because the potential for
time savings and admission prevention is huge.
Jason Kendall.
"Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR" wrote:
> Jason Kendall has done a huge amount of work on near patient testing in A
> and E. My understanding from one of his presentations was that it wasn't as
> cost effective as one would hope (or in my case expect). Anyone from Bristol
> able to update us on what the line is?
>
> Matt Dunn
> Warwick
>
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