I have just discovered our Trop-T machine has cost us £16k this year.
Bearing in mind how rarely a positive Trop-T affects a fast track
decision to thrombolyse (i.e. it doesn't) I propose to give it the bird.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: 12 March 2003 11:22
To: [log in to unmask]
Subject: Re: near patient testing
I suppose it depends on the kit Goat. Our ABG machine is dead easy; any
time spent feeding the machine is offset by not having to fill forms
in/label samples/feed the vacuum shute etc. Our troponin is a bit slow,
but you normally do something else while you're waiting for the 12
minutes to brew, well, I assume the SHOs do something else rather than
watch the machine for 12 minutes! I don't have experience of other
machines, but I agree they'd only be viable if real easy to use.
Adrian
> from: Goat <[log in to unmask]>
> date: Wed, 12 Mar 2003 07:48:18
> to: [log in to unmask]
> subject: Re: near patient testing
>
> Do the cost-benefit equations include the cost of ED staff time in
> doing the tests? I have always been suspicious of any change in
> working practice that dumps more jobs on clinical staff that can, and
> should be done by non- clinical staff.
> Time-critical stuff (gases, BM, ?troponins, K ), fine. But not the
rest.
> I had some experience as an SHO in an ED with a gadget which did
> amylase, U E, Hb, CK etc. The labs closed their weekend service and
> PRHOs / staff nurses spent their life doing tests that were perhaps
not
> urgent, but couldn't wait until Monday. Waiting times went through the
> roof and the labs quickly re-openend their OOH service.
> Modern thin film technology for NPT is quicker and more reliable, but
I
> still reckon the lab staff should be doing the tests (if needs be in
the
> ED), rather than put another time demand on front-line clinical staff.
>
> Goat
>
>
> In article <[log in to unmask]>, Jason Kendall
> <[log in to unmask]> writes
> >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.
>
> Dr G Ray
> A&E
> Sussex
> Reply to [log in to unmask]
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