Near-patient testing

O. Sanehi1, U. R. Jahn2 and H. Van Aken2

1 Hale, UK 2 Münster, Germany

Editor—Jahn and Van Aken1 rightly point out that near-patient testing is justified if it results in improved patient care, but they downplay the importance of the increased convenience to staff of such techniques. The part which convenience plays in the way doctors work should not be underestimated—improved patient care may occur by virtue of the increased convenience. I give two instances in which convenience probably made the difference between performing a test and doing without; I am sure there are many others.

Near-patient testing played a large part in a change in the practice of perioperative blood transfusion in a large teaching hospital.2 Rates of blood transfusion were audited before and after the introduction of guidelines, which included a measurement of haemoglobin prior to transfusion. Although there was easy access to laboratory haemoglobin measurement, it was felt that near-patient measurement would be essential to improve compliance with the guidelines. It is possible that the introduction of the guidelines alone was responsible for the increased rate of pre-transfusion haemoglobin measurement, and the resulting drop in the rates of inappropriate blood transfusions. However, I believe that the increased convenience afforded to the doctor by near-patient testing will often have made the difference between measurement and non-measurement. In another (unpublished) audit of our own practice at Trafford General Hospital, the introduction of near-patient testing of arterial blood gas tensions in an intensive care unit increased the rate of measurement from approximately 2400 to 3300 a year.

It must be conceded that in neither of these cases is it definitely established that the result of increased testing was an improvement in patient care (and indeed it would be difficult to do so using crude measures of outcome such as mortality). However, if we believe that testing is not done for its own sake, and that the results of tests are acted upon appropriately, it is difficult to believe that the added convenience of near-patient testing did not contribute to such an improvement.

O. Sanehi

Hale, UK

Editor—We appreciate Dr Sanehi’s interesting comment on our Editorial,1 pointing out that the increased convenience provided by near-patient testing in comparison to conventional laboratory measurements might be the underlying cause of improved patient care. In the clinical setting described by Sanehi, where the fulfilment of guidelines might be dependent on or improved by an increased convenience of laboratory testing, this argument is understandable. Thus, an increase in measurement rates under these circumstances is not surprising; rather it is to be expected.

However, we disagree with Dr Sanehi’s opinion that the increased convenience might make a difference to outcome, although we welcome any enhanced convenience during the daily routine. We are convinced that the use of near-patient testing and also its performance have to be determined by clear indications. The convenience of testing must not lead to higher testing rates. Uncritical and unjustified expansion in near-patient testing, and an uncritical and convenience-based increase in testing rates beyond clear indications, will provide an uneconomic quantity of data, increase costs and not be a benefit to the patient. In addition, it has to be re-emphasized that quality control of the data is mandatory.

Near-patient testing is not necessarily considered convenient; it may be associated with reduced acceptance and satisfaction among some staff.3 Like Dr Sanehi, we believe that near-patient ‘testing is not done for its own sake’, but we feel that the convenience of laboratory tests—performed when they are really indicated—cannot and must not influence the frequency and benefits of patient testing.

U. R. Jahn

H. Van Aken

Münster, Germany

References

1 Jahn UR, Van Aken H. Near-patient testing—point-of-care or point of costs and convenience? Br J Anaesth 2003; 90: 425–7[Free Full Text]

2 Mallett SV, Peachey TD, Sanehi O, Hazlehurst G, Mehta A. Reducing red blood cell transfusion in elective surgical patients. Anaesthesia 2000; 55: 1013–9[CrossRef][ISI][Medline]

3 Kilgore ML, Steindel SJ, Smith JA. Evaluating stat testing options in an academic health centre: therapeutic turnaround time and staff satisfaction. Clin Chem 1998; 44: 1597–603[Abstract/Free Full Text]





This Article
Full Text (PDF)
E-Letters: Submit a response to the article
Alert me when this article is cited
Alert me when E-letters are posted
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Disclaimer
Request Permissions
Google Scholar
Articles by Sanehi, O.
Articles by Van Aken, H.
PubMed
PubMed Citation
Articles by Sanehi, O.
Articles by Van Aken, H.