Authors' objectives:

The CEDIT was contacted by the Director General of the AP-HP and asked to assess the value of patient bedside laboratory kits, which constitute a special form of delocated laboratory medicine. This term means 'laboratory procedures carried out outside medical laboratories by personnel with no training in laboratory medicine, usually by nurses'.

Authors' results and conclusions: There is less literature available on the medical usefulness of the system than on its technical characteristics. The data analyses published and the opinions voiced by experts do, however, reveal some important points: Positive features: User satisfaction with the system in routine use is good,particularly in Neonatal Departments, where its main advantage is the microsampling procedure, which makes it possible to economise blood and so reduces the number of transfusions required by premature babies. Results are available much sooner (the time saved is of the order of 1 to 2 hours in the French studies), with results available virtually instantly (2 to 3 minutes). The simplification of the procedures reduces the risk of pre- or post-analysis errors. Some negative features remain: The impact in terms of health benefit for the patients remains to be demonstrated, except in the context of neonatal use. The organisational impact has not been established either. In particular, no change in the mean length of stay in the emergency department has been observed. The samplingprocedures expose the operator to a greater risk of contamination by accidental contact with the patient's blood (particularly as the needle is being removed from the syringe). The complexity of the procedures for identifying the patient (12 digits to be keyed in twice) and the person taking the sample (ditto) is a real source of difficulty and definitely requires improvement by a bar code scanning wand. The consumables (cartridges) are expensive.

Authors' recommendations: NB The following conclusion was developed exclusively for the Chief Executive Officer of the AP-HP, the public hospital network of Paris area, for his use as an aid in the decision making process. In any other context, it should be considered nothing more than an element of information. The CEDIT thinks that the advent of systems which make it possible to carry out laboratory medicine tests at the patient's bedside is a step forward in patient care. However, the clinical, organisational and juridical implications of these systems must be clarified and their provision organised.

Authors' methods: Overview

Project Status: Completed

URL for project: http://cedit.aphp.fr/

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Organisation Name: Cellule Innovation of the AP-HP

Copyright: Comite d'Evaluation et de Diffusion des Innovations Technologiques