The Patient and Decentralized Testing PDF
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THE PATIENT AND DECENTRALIZED TESTING THE PATIENT AND D ECENTRALIZED TESTING f.dlted by J. P. Ashby Department of Clinica./ Chemistry Northwick Park Hospital and Clinica/ Research Centre Harrow, Middlesex, UK Proceedlngs of the ECCLS Conference on Decentraiized Clinica! Training held in Copenhagen. 1 1-!Zth August 1986. SPRINGER-SCIENCE+BUSINESS MEDIA, B.V. Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England British L.ibrary Catalogu.ing in Publication Data The Patient and decentralized testing. 1. Pathological services. I. Ashby, J .P. 616'.075 RB37 ISBN 978-94-010-7926-6 ISBN 978-94-009-3179-4 (eBook) DOI 10.1007/978-94-009-3179-4 Published in the USA by MTP Press A division of Kluwer Academic Publishers 101 Philip Drive Norwell, MA 02061, USA Library of Congress Cataloging-in-Publication Data ECCLS Seminar (7th : 1986 : Copenhagen, Denmark) The patient and decentralized testing. Includes bibliographies and index. 1. Diagnosis, Laboratory--Congresses. 2. Medical innovations--Congresses. I. Ashby, J. P. II. Title. [DNLM: 1. Delivery of Health Care--organizations & administration--congresses. 2. Diagnosis, Laboratory- congresses. 3. Technology, Medical--trends--congresses.] W3 EC12 7th 1986p 616.0715 87-2737 Copyright 1987 Springer Science+Business Media Dordrecht Originally published by MTP Press Limited in 1987 Softcover reprint of the hardcover lst edition All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electroni~, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. Co:r1ter1ts Preface FL Mitchell vii List of Contributors viii Foreword R Dybkaer X Welcoming Address JE Asvall xiii PART l, WHAT IS THE NEED FOR DECENTRALIZED TESTING? 1 The need for decentralized testing - a patient's view E Seidenfaden 3 Discussion 8 2 The need for decentralized testing - a general practitioner's view P Backer 9 3 The need for decentralized testing - a hospital clinician's view P Riis 13 4 The need for decentralized testing - a laboratorian's view N Tryding 15 Discussion 20 PART 2 WHAT IS BEING PROVIDED BY INDUSTRY FOR DECENTRALIZED TESTING? 5 Equipment for the side ward, the doctor's premises and the patient's home C Kirkemo 23 PART 3 IS THE CHANGED RESPONSIBIT.ITY WELCOME? 6 Is the changed responsibility welcome? A nurse's view M Locker de Bruijne 33 7 Is the changed responsibility welcome? A laboratorian's view G Smart 37 Discussion 40 v CONTENTS PART 4 THE ROLE OF ECCLS IN STANDARDS FOR GOOD PRAC TICE IN DECENTRALIZED CLINICAL LABORATORIES 8 Premises and operational units DM Browning 43 Discussion 4 7 9 Methods and reagents H Kiiffer 49 Discussion 53 10 Safety of personnel and environment RD Jennings 57 Discussion 60 11 Patient reception, preparation, specimen handling and data flow CE Wilde 63 Discussion 72 12 Quality assurance, teaching and training D Kutter 73 Discussion 83 13 Special considerations in haematology and blood banking DW Dawson 85 Discussion 88 14 Special considerations in histopathology N. Stormby 89 Discussion 91 15 Organization and management in the decentralized laboratory RM Rowan 93 Discussion 100 PART 5 COST IMPLICATIONS OF DECENTRALIZED TESTING 16 Cost implications of decentralized testing - a health agency's view R Netter 105 Discussion 107 17 Cost implications of decentralized testing - a laboratorian's view R Haeckel 109 Discussion 117 PART 6 SUMMARY AND CONCLUSIONS 18 The need for guidelines for decentralized clinical testing R Dybkaer 121 vi P:refa.ce For this the seventh and subsequent seminars, the Board of ECCLS has decided that to maximize local input and generally im porve the efficiency of organization, a selected country might be asked to host a conference around the chosen topic and be respon sible for all organizational details. The new title of 'Conference' would be applied since it suits better the distinctive character which the annual meetings of ECCLS have assumed. This year the title chosen for the seminar - Decentralized Clinical Testing - had the same theme as that expressed in the title of a newly formed standing action committee - Good Practices in Decentralized Clinical Laboratories - chaired by Dr Dybkaer in Copenhagen. This committee has seven subcommittees and it seemed most appropriate that between them, with extra invited speakers, they should run the conference as an expanded meeting of the committees with participation from all registered attendees. Contrary to the situation in previous seminars, Dr Dybkaer was able to structure the presentations and debate, thus ensuring optimal output, and the result was most rewarding in every way. The presentations of Danish experts in various aspects were par ticularly appreciated. FL Mitchell ECCLS Chairman vii JE ASVALL R DYBKAER WHO Regional Office for Europe Department of Clinical 8, Scherfigsvej Chemistry DK-2100 Copenhagen Frederiksberg Hospital Denmark Nordre Fasanvej 59 DK-2000 Frederiksberg P BACKER Denmark Institute for General Practice University of Copenhagen R HAECKEL Juliane Maries Vej 18 lnstitut fUr DK-2100 Copenhagen Laboratoriumsmedizin Denmark Zentralkrankenhaus St JUrgen Strasse DM BROWNING D-2800 Bremen 1 Department of Clinical FRG Chemistry Wolfson Research Laboratories RD JENNINGS Queen Elizabeth Medical Centre Department of Health and Edgbaston Social Security Birmingham B15 2TH Medical and Scientific UK Services Division Hannibal House DW DAWSON Elephant and Castle Department of Haematology London SE1 GTE North Manchester General UK Hospital Manchester M8 6RB C KIRKEMO UK Abbott Diagnostic Products GmbH Max Planck Ring 2 D-6200 Wiesbaden-Delkenheim FRG viii LIST OF CONTRIBUTORS H KUFFER E SIEDENFADEN Institut Central des H6pitaux Vissinggaard Valaisans DK-8740 Braedstrup Division Chimie Clinique Denmark CH -1951 Sion 3 Switzerland G SMART Pathology Department D KUTTER Southampton General Hospital PO Box 748 Tremona Road L-2017 Luxembourg Southampton S09 4XY Luxembourg UK N STORMBY M LOCKER de BRUIJNE Division of Cytopathology Nursing Service Malmo General Hospital Hugo de Vriesweg 8 S-214 01 Malmo NL-9751PS Haren Sweden The Netherlands N TRYDING R NETTER Department of Clinical Laboratoire National de la Chemistry Sante Central Hospital 25 Boulevard Saint Jacques S-291 85 Kristianstad F-75014 Paris Sweden France CE WILDE P RIIS Department of Clinical Department of Medical Chemistry Gastroenterology Doncaster Royal Infirmary Herlev University Hospital Armthorpe Road Herlev Ringvej Doncaster DN2 5LT DK-2730 Herlev UK Denmark RM ROWAN Department of Haematology Western Infirmary Glasgow Gll 6TN UK ix Decentralized clinical testing reaches back into antiquity as uros copy, the scrutiny of urine and its sediments, then alchemy was applied by Philippus Aureolus Theophrastus Bombastus von Hohen heim alias Paracelsus (1493-1541), and later more specific proce dures were introduced by Robert Boyle (1627-1691). The first clinical chemical laboratory was created in 1842 by Johann Joseph von Scherer in Wlirzburg, Germany, to reveal pathobiochemistry through more sophisticated analyses. Ward room and bedside test ing, however, still thrived. The insatiable demand for clinical tests in ever-increasing numbers and varieties of quantities necessitated the birth, around the middle of this century, of the mastodont ic, multipurpose and machine-cluttered central laboratory where the necessary expensive equipment and expertise could be utilized economically. The pendulum is now swinging back towards analysis nearer the patient. There are three major reasons: ( 1) the increasing political emphasis on primary health services, (2) the timely monitoring of patients, and ( 3) the technical possibilities offered by analytical systems with an ingenious amalgamation of physics, electronics, chemistry and microprocessors, permitting selective analysis with inbuilt calibration and quality control. An awkward problem of this development is that the new equipment is often described as being problem-free for virtually any user after a min imum of instruction. Sometimes the claim is hedged by reassuring that screening results need not be as exact as those offered in a hospital by the central laboratory. This comforting viewpoint, however, is dangerous because the fate of a patient may well hinge on the primary result. As regards trouble-free operation, it remains an unobtainable ideal in spite of sophisticated engineering, and the detection of some malfunctions - not to mention repair - may require an experienced laboratorian rather than the casual X
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