Withdrawn Tests‘The Second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Varied response from Trusts No clear pattern of withdrawn tests Hard to target areas for action Responses from 15 Trusts Many had tests were identified by single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Consultant only requests Tests considering for withdrawal Withdrawn tests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copper and zinc  1 10    Alpha 1 acid glycoprotein* 3 5 4 withdrawn already (3)Other - Please specify        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Withdrawn Tests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Withdrawn Tests (2)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…