As has been pointed out by Martin Myers this is an important debate that
we need to have explored thoroughly so that when Commissioners are using
PbR we can give a coherent consensus rationale for what we are doing. I
would suggest that we should be looking to determine the minimum order
set compatible with meaningful interpretation in the majority (?>90%) of
patients and we should consider context i.e. hospital v GP.
it may be that we can save a lot of money by not doing GP ureas, but
that should be reinvested in adding T4 to TSH if not already done.
If we don't determine our own minimum quality standards, someone else
will.
So is it?:
renal: Na K creat urea [hospital] Na K creat (+ eGFR)[GP]
liver: Bili ALT or AST ALP ?+tot prot alb
bone Ca Alb PO4 ALP
Thyroid TSH (f)T4
The % of reflex tests added to each profile might become relevant if
high numbers, so some consideration of that too is needed.
Dr Ian D Watson
Consultant Biochemist & Toxicologist
Dept Clinical Biochemistry
University Hospital Aintree
Liverpool
L9 7AL
tel 01515293575
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