scholarly journals Emergency Biochemistry Services—Are They Abused?

1982 ◽  
Vol 19 (5) ◽  
pp. 325-328 ◽  
Author(s):  
A D Stuart Smith ◽  
Alan Shenkin ◽  
Frances J Dryburgh ◽  
H Gemmel Morgan
Keyword(s):  
Emergency Service ◽  
Medical Laboratory ◽  
Royal Infirmary ◽  
Concomitant Increase ◽  
Out Of Hours ◽  
Medical Practitioners ◽  
Laboratory Services ◽  
Industrial Dispute ◽  
Clinical Biochemist

An out-of-hours emergency biochemistry service, which allows access by all medical practitioners of varying experience within a hospital, can lead to overuse or even abuse of limited and costly facilities. When the workload increases, problems of staffing a voluntary (but paid) working rota may emerge. An industrial dispute involving medical laboratory scientific officers (MLSOs) caused the role of the emergency service to be examined and alternative regulating mechanisms to be tested. Experience at Glasgow Royal Infirmary between 1974 and 1981 has been reviewed. From 1977 to 1979, when clinicians (usually junior) arranged analyses directly with the MLSOs, test numbers increased by about 26% per annum. This was not associated with any concomitant increase in the range of analyses offered. During a five-week period in 1980, consultant clinicians had to contact a consultant clinical biochemist to arrange all emergency analyses, and test numbers were reduced to 13% of the previous levels. Subsequently, all requests for emergency analyses were made by clinicians to laboratory medical staff, and test numbers fell to approximately 60% of 1979 levels. This requesting system is now firmly established. Continued vigilance is required to maintain the reduced level of requesting, but too great a limitation on emergency requests may cause less efficient patient management. Senior clinical staff should be encouraged to take greater responsibility for the use of emergency laboratory services.

The role of the physician in laboratory medicine: a European perspective

2012 ◽  
Vol 66 (5) ◽  
pp. 432-437 ◽  
Author(s):  
Siraj A Misbah ◽  
Vana Kokkinou ◽  
Katie Jeffery ◽  
Wytze Oosterhuis ◽  
Brian Shine ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Laboratory Medicine ◽  
Vital Role ◽  
Added Value ◽  
Medical Laboratory ◽  
Diagnostic Laboratory ◽  
Laboratory Services ◽  
Science Laboratories ◽  
Laboratory Technology

Advances in medical laboratory technology have driven major changes in the practice of laboratory medicine over the past two decades by the development of automated, cross-disciplinary single platform analysers. This has led to the blurring of boundaries between traditional disciplines and the emergence of core automated or blood science laboratories. This paper was commissioned by the Union of European Medical Specialists to examine the changing role of laboratory-based physicians in the light of these advances by focusing on the added value of expert interpretation of test results and resultant improvements in clinical outcomes. The paper also considers the broad range of responsibilities of laboratory-based physicians and the difficulties in precisely measuring how this translates into improved clinical outcomes. Given its provenance, the paper concentrates predominantly on the role of laboratory-based physicians while acknowledging the essential and vital role of scientists in running diagnostic laboratory services.

scholarly journals Lab Wisely in Canada: Enhancing and highlighting the role of all clinical laboratory professionals in reducing harm and waste

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S117-S117
Author(s):  
A VanSpronsen ◽  
C Nielsen ◽  
B Djukic ◽  
V Villatoro
Keyword(s):  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Significant Proportion ◽  
Choosing Wisely ◽  
Medical Laboratory ◽  
Medical Overuse ◽  
Specimen Collection ◽  
Laboratory Services ◽  
Inappropriate Utilization

Abstract Introduction/Objective Stewardship initiatives are a key strategy for addressing inappropriate utilization of clinical laboratory resources. These approaches require engagement of multiple types of stakeholders. Some professional groups are historically underrepresented, such as those who perform specimen collection, testing, and quality processes. A specific campaign is needed to engage these groups and highlight their expertise. Methods/Case Report We surveyed Medical Laboratory Technologists and Medical Laboratory Assistants to understand the barriers they face to participating in laboratory stewardship initiatives. These survey findings helped shape tools and resources that we created for new campaign called Lab Wisely. We also identified that one-third of existing Choosing Wisely Canada recommendations relate to laboratory testing. We categorized and tagged each recommendation to create a publicly-available searchable database which was placed on the campaign website (LabWisely.ca). Results (if a Case Study enter NA) NA Conclusion Laboratory testing is featured in a significant proportion of all Choosing Wisely Canada recommendations, supporting the idea that the clinical laboratory should be heavily involved in reducing medical overuse in healthcare. In our survey, we found that laboratory professionals face time and workload constraints, but feel a professional responsibility for ensuring appropriate resource use by all users. There was also a lack of ‘know- how’ around tangible ways to become involved. The Lab Wisely website has become a one-stop-shop for highlighting the role of technical and scientific professionals in laboratory stewardship and providing concrete tools that can be used to develop capacity in these groups. Every level of staff can and should be involved in improving the utilization of clinical laboratory services.

450 Retrospective Analysis of Surgical Clerk-Ins Within the Acute Receiving Unit: A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Lee ◽  
A MacLeod ◽  
A Bradley
Keyword(s):  
Royal Infirmary ◽  
Improvement Project ◽  
Out Of Hours ◽  
Emergency Admissions ◽  
Vte Prophylaxis ◽  
Care Services ◽  
Documentation Quality ◽  
Patient Documentation ◽  
Patient Handovers

Abstract Introduction Accurate patient documentation at the ARU is vital to patient safety and ensuring smooth handovers to secondary care services. Because the nature of surgical treatment requires frequent patient handovers, and this increases the risk of miscommunication, we aimed to assess the quality of surgical clerk-ins and identify areas for improvement. Method Emergency admissions at the Dumfries Galloway Royal Infirmary were audited, looking at documentation quality under various clerk-in sections. Data was analysed before presentation to clinical governance. Results When 46 patient clerk-ins were examined, venous thromboembolism (VTE) prophylaxis plans were performed in only 24% of admissions - less than 1 in 4 patients. Comparing out-of-hours and in-hours patient documentation, much higher omission rates were identified in the out-of-hours documentation: in systemic enquiry (42 vs 100%) and family history (31% vs 66%). Conclusions These results brought to attention the effect of hospital admission timing on patient documentation quality, and the lack of VTE prophylaxis planning. In surgery, these plans are key to minimising risk of avoidable thromboembolic complications. A departmental meeting was convened to stress the importance of accurate and comprehensive clerk-ins to ARU doctors. Future audits could explore the factors influencing documentation quality for out-of-hours admissions, and ways to address these issues.

Stiffen the sinews, summon up the blood, and strain upon the start: enfranchising the medical profession for clinically proximate advocacy of improved healthcare

2021 ◽  
pp. 103985622110250
Author(s):  
Jeffrey C L Looi ◽  
Stephen Allison ◽  
Stephen R Kisely ◽  
Tarun Bastiampillai
Keyword(s):  
Resource Allocation ◽  
Health Systems ◽  
Medical Profession ◽  
Continuing Professional Development ◽  
Health Advocacy ◽  
Public And Private ◽  
Medical Practitioners ◽  
The Public ◽  
Team Activity

Objective: To discuss and reflect upon the role of medical practitioners, including psychiatrists, as health advocates on behalf of patients, carers and staff. Conclusions: Health advocacy is a key professional competency of medical practitioners, and is part of the RANZCP framework for training and continuing professional development. Since advocacy is often a team activity, there is much that is gained experientially from volunteering and working with other more experienced health advocates within structurally and financially independent (of health systems and governments) representative groups (RANZCP, AMA, unions). Doctors may begin with clinically proximate advocacy for improved healthcare in health systems, across the public and private sectors. Health advocacy requires skill and courage, but can ultimately influence systemic outcomes, sway policy decisions, and improve resource allocation.

The role of the registered nurse first assistant within the perioperative setting

2021 ◽  
Vol 30 (3) ◽  
pp. 148-153
Author(s):  
Roland Pika ◽  
Brid O'Brien ◽  
Jill Murphy ◽  
Kathleen Markey ◽  
Claire O'Donnell
Keyword(s):  
Registered Nurse ◽  
Healthcare Sector ◽  
Review Of The Literature ◽  
Surgical Interventions ◽  
Medical Practitioners ◽  
Nursing Role ◽  
Perioperative Nursing ◽  
Recent Emergence ◽  
Provision Of Care

Perioperative setting registered nurse first assistants (RNFAs) are described as non-medical practitioners who perform surgical interventions during surgery. They provide medical care to perioperative patients under the supervision of a consultant surgeon. First assistants in surgery can be an expanded perioperative nursing role. A review of the literature illuminates the need for continuous learning in developing skills in becoming competent RNFA practitioners and how they utilise acquired skills to assist, mentor and teach their colleagues within the perioperative setting. The RNFA is an advanced and expanded practice role. RNFAs contribute significantly to the provision of care within all phases of perioperative care (preoperative, intraoperative, postoperative). There is little literature on the role of the RNFA due to its relatively recent emergence in the healthcare sector and the small number of countries where it is implemented.

scholarly journals Early pyrexia after endovascular aneurysm repair: are cultures needed?

2011 ◽  
Vol 93 (2) ◽  
pp. 111-113 ◽  
Author(s):  
L Corfield ◽  
J Chan ◽  
T Chance ◽  
N Wilson
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Blood Cultures ◽  
Stent Insertion ◽  
Out Of Hours ◽  
Microbiological Investigation ◽  
Significant Difference ◽  
Aneurysm Repair ◽  
Infective Complications ◽  
Post Implantation

INTRODUCTION The post-implantation syndrome after endovascular aneurysm repair (EVAR) is increasingly recognised. However, when non-vascular trainees are responsible for the care of these patients out of hours, many are investigated if pyrexial. This study assesses the role of microbiological investigations in pyrexia after endovascular aneurysm repair. PATIENTS AND METHODS The notes of 75 EVAR patients were reviewed retrospectively. The incidence of postoperative pyrexia and infective complications were calculated and the result of any cultures obtained. RESULTS Overall, 58 (77.3%) patients were pyrexial with 48 h of stent insertion. Twenty-four had blood cultures and 12 had urine cultures taken within 48 h of surgery. All of these cultures were negative. However, of those with a pyrexia after 48 h, one of nine blood cultures and two of 11 urine cultures grew organisms. Five pyrexial patients and one apyrexial patient developed a wound infection (a non-significant difference, P = 1.00). CONCLUSIONS Pyrexia within 48 h of EVAR is common. Microbiological investigation in the first 48 h in these patients is unrewarding. After 48 h, cultures are more likely to show growth. Although each patient must be assessed clinically for signs of sepsis, blood and urine cultures within 48 h of EVAR are generally unnecessary.

scholarly journals The Role of IL-37 and IL-38 in Obstetrics Abnormalities

2021 ◽  
Vol 8 ◽  
Author(s):  
Mei Wang
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Inflammatory Mediator ◽  
Inflammatory Responses ◽  
Medical Practitioners ◽  
Minimal Difference ◽  
Anti Inflammatory ◽  
Umbilical Cords

There are two fairly common complications during pregnancy, i.e., gestational diabetes mellitus (GDM) and pre-eclampsia, which are independent, but are also closely linked in prevalence in pregnant women, with potential serious adverse consequences. IL-37 and IL-38, which belong to the IL-1 superfamily, participate in anti-inflammatory responses. Dysregulation of IL-37 and IL-38 has been observed in many auto-immune diseases. IL-37 is substantially reduced in the umbilical cords and placentas of GDM subjects, but IL-37 is significantly induced in the placentas of pre-eclampsia patients, suggesting there are differential regulatory roles of IL-37 in obstetrics, despite IL-37 being an anti-inflammatory mediator. Furthermore, IL-38 is substantially increased in the umbilical cords and placentas of GDM subjects, but minimal difference is observed in the placentas from pre-eclampsia patients. These data imply that IL-38 is also regulated independently within the diseased placentas. This review provides some insight for both basic scientists and medical practitioners to manage these patients effectively.

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