sarah heap 16.4.12. varied response from trusts no clear pattern of withdrawn tests hard to...
TRANSCRIPT
Withdrawn Tests‘The Second
Questionnaire’Sarah Heap
16.4.12
Varied response from Trusts No clear pattern of withdrawn tests Hard to target areas for action Responses from 15 Trusts Many had tests were identified by single
respondents
Plan Recirculate amended questionnaire
Initial findings
Sent out 27.3.12 8 respondents (more following prompting at
meeting) More useful data
Consultant only requests Tests considering for withdrawal Withdrawn tests
Short response time If you’re here and you’ve not responded please,
please, please can I have your data!
Q2
Yes No (offered to all) No response Additional InfoSerum Free Light Chains 4 5 1
Haem consultants (2), Immunology (2), Haem (1)
Thyroglobulin 1 8 1 if approp to patient (4)
Faecal Calprotectin 3 6 1not lab funded (2), never offered(1)
Urine myoglobin* 1 7 1
CK in range 500-10000 dipstick +ve (1) vetted/muscle specialist (1)
Antinuclear antibodies pattern and titre 9 Immunology (3)
HLA DQ2/8 2 6 1gastro- consultants(2), Immunology (2)
fT3/fT4 (use of rule based system) 5 6
fT3 rule based (3) TSH only (3), dependent on other results(8), t3 for endocrinologists
genetic testing 6 3 1requestor charged (2), vet (2)
CRP 10 hsCRP for funded research (1)
Consultant only requests
Yes No n/a Additional Info
FOB 5 1 4 GP - pregnancy test 5 6 other dept(3)
urea 10
copper and zinc 1 10 Alpha 1 acid glycoprotein* 3 5 4 withdrawn already (3)Other - Please specify
AST 1 24hr urine protein 1
random protein/creat ratio (NICE)
Tests considering for withdrawal
Yes No no response Additional Info
FOB* 5 5 1 Alpha 1 acid glycoprotein* 3 6 1 if CRP normal
CKMB* 11
faecal chymotrypsin* 9 2
Faecal fats* 10 1
sweat sodium* 7 2 2 Amniotic fluid AFP/ acetylcholinesterase* 5 5 Amniotic fluid lecithin/sphingomyelin ratio* 5 5 Amniotic fluid optical density* 5 5
Withdrawn Tests
Yes No n/a Additional Info
CHD risk* 6 3 2
equilibrium dialysis fT4* 3 5 2
Immunoreactive trypsin* 9 1
lactose tolerance test* 6 4 1
lactulose/mannitol* 7 1 2
Prolonged GTT* 3 5 2
Spot IMD test(FeCl, MMA, CNP, DNPH)* 6 2 1
Urine Thiosulphate* 7 2 1
troponin T* 4 6 1never offered (1), hsTropT (2)
Urine cotinine* 7 2 +1
urine microalbumin O/N timed collection* 5 5
valproate* 1 10
Withdrawn Tests (2)
CKMB Faecal fat Colloid oncotic pressure Pancreolauryl test Red cell transketolase Amniotic fluid optical density Amniotic fluid AFP/cholinesterase Amniotic fluid lecithin/sphingomyelin ratio
The Rest…
The definites…
Address those tests with split yes/no Expert opinion in that area
Endocrinology, IMD etc Labs still offering/supporting use
Workload data Ensure data covers funded tests More data from other labs Come up with a consensus opinion
Vetting subgroups
Plan
Can we use this to centralise tests with smaller numbers?
Promote good practice
Can we use the data to help us manage pathology regionally?
Tests suggested are not those with vast workloads
Have we been radical enough?
But…