Iddexx Vettest

Re: Iddexx Vettest

bob lehner — Fri, 05 Oct 2012 14:28:51 GMT

[

[quote user="Gillian Mostyn"]Does the PSS make it a stipulation for registration at all? Just curious.[/quote]

FYI - From PSS Manual.

GP SA level:

'There must be a clinical microscope, and facilities to assess packed cell volume,
prepare blood smears, and to measure blood glucose, blood urea concentrations and
urine specific gravity.' (BU may be done off site provided results are available suitably rapidly)..

VH SA level:

Laboratory facilities for routine diagnostic tests must be available at all times. Where
laboratory facilities are not provided on site, suitable arrangements must be made to
enable laboratory investigations on emergency cases.

Suitable arrangements must be made for the following detailed investigations:
• Biochemistry;
• Haematology;
• Parasitology;
• Bacteriology.

The following equipment must be provided on the premises:
• Binocular microscope with mechanical stage, electric light source and oil
immersion facility;
• Centrifuge suitable for PCV, blood separation and urine sedimentation;
• Urinary refractometer;
• Biochemistry analyser to include Creatinine, Urea, Glucose, Total Protein and
Calcium;
• Electrolyte analyser.

+ Ability to look at smears on site'.

Documented evidence of Quality Control of the practice in-house lab is also required.

Re: Iddexx Vettest

Bob Russell — Fri, 05 Oct 2012 10:25:27 GMT

The world has changed and the days of packing up samples and posting them, waiting 2 days for results are over for many practices. External labs have really got their act together so should our machines fail permanently it is far from clear if they would be replaced.

Re: Iddexx Vettest

Michael Woodhouse — Thu, 04 Oct 2012 21:40:53 GMT

When we bought the practice we also bought the VetTest machine. Allowing for the fact I paid almost nothing for it I cannot make it work financially. I'd have to charge more money for inferior results. Not to mention wasted slides, QC etc.

It is going up in the loft.

Re: Iddexx Vettest

Evelyn Barbour-Hill — Thu, 04 Oct 2012 19:16:07 GMT

Machines have rotas?

Re: Iddexx Vettest

Mark Holmes — Thu, 04 Oct 2012 17:36:56 GMT

[quote user="Anthony Todd"]

[quote user="Mark Holmes"]

I would largely agree with you Gillian, I have run into alot of problems with blood machines, and the variety and reliability of external lab options genrally results in a better deal. I would think though that labour costs packaging and posting bloods or running a machine are similar.[/quote]

We ran in-house lab equipment for nearly two years and our experience was:

1. The total percentage of lab tests per consult, both in-house and send-off went down. That's with an effective overnight service.

2. The equipment was not trouble free and the remedy, when we got onto support [at our cost] and went through their exhaustive and basic interrogation [did you use a dry syringe etc. etc.?] was "send another sample to us and we'll do it free of charge" or "we'll send you a replacement machine" [T4!!] Owners are really happy bringing their pet back for another sample!

Usually their in house log of faults blamed "operator error", which really infuriated the only really switched on tech. we had.

The support was based on our reporting an error code and then being told, after the client had left ,or we had time to ring, that error 23456 was that the instrument was too hot and to open the window or "turn it off and on again". I eventually ,with enormous difficulty got an error code sheet after consultation with Holland which reduced the number of fruitless support calls.

The reason given was so that they could log the faults!!!!

3. Most of the tests, when you factor in cleaning, calibration, and cost of components was much more than send-off, and then there's the leasing, insurance and labour.! Even when factoring in the apparently generous discounts.

Components had to be delivered refrigerated and there was always a delivery fee.

4. The procedures are NOT foolproof, and vets are the world's worst lab. techs.! To say nothing of £300 worth of reagents left out of the freezer....

5. Whilst there is always the case which needs urgent bloods, they are rare and you can always get a special courier on a bike to rush it to the lab.

Actually you could send them all in a chauffeur driven Roller as many times as you liked and you'd be quids in, accurate, repeatable results, no hassles with support and a much easier life!

If you are thinking of getting in-house kit do your sums very carefully!

[/quote]

Thats very interesting and useful. I guess factoring in wasted reagent and outdated rotas and hours of phone calls are somethings that would be missed when doing the maths.

Re: Iddexx Vettest

Anthony Todd — Thu, 04 Oct 2012 17:16:34 GMT

[quote user="Mark Holmes"]

We ran in-house lab equipment for nearly two years and our experience was:

1. The total percentage of lab tests per consult, both in-house and send-off went down. That's with an effective overnight service.

Usually their in house log of faults blamed "operator error", which really infuriated the only really switched on tech. we had.

The reason given was so that they could log the faults!!!!

Components had to be delivered refrigerated and there was always a delivery fee.

4. The procedures are NOT foolproof, and vets are the world's worst lab. techs.! To say nothing of £300 worth of reagents left out of the freezer....

5. Whilst there is always the case which needs urgent bloods, they are rare and you can always get a special courier on a bike to rush it to the lab.

Actually you could send them all in a chauffeur driven Roller as many times as you liked and you'd be quids in, accurate, repeatable results, no hassles with support and a much easier life!

If you are thinking of getting in-house kit do your sums very carefully!

Re: Iddexx Vettest

Gillian Mostyn — Thu, 04 Oct 2012 16:41:53 GMT

[quote user="Bob Russell"] I admit I would not like to return to our old Iddexx set up through choice but many practices are happy with them![/quote]

Many practices are happy with lots of things I wouldn't be - and I am sure the opposite is also true!

Re: Iddexx Vettest

J G Wray — Thu, 04 Oct 2012 16:30:49 GMT

[quote user="Gillian Mostyn"]sorry - no time to trawl the journals - any chance of summarising?[/quote]

Stick to what you're doing. Everyone forgets costing nurse/vet/auxiliary time when they say anyone can do in house tests.

JGW

Re: Iddexx Vettest

Gillian Mostyn — Thu, 04 Oct 2012 16:02:07 GMT

J G Wray,

sorry - no time to trawl the journals - any chance of summarising?

Re: Iddexx Vettest

Hannah Wynne Richards — Thu, 04 Oct 2012 15:53:22 GMT

That's because in-house dry biochem was the latest thing then

Wynne

Re: Iddexx Vettest

J G Wray — Thu, 04 Oct 2012 15:30:19 GMT

This has all been comprehensively discussed elsewhere

Clinical Practice Companion Animal Practice: Getting results in clinical pathology 2. Pros and cons of in‐clinic haematological testing

Mark Pinches

In Practice 2006;28:3 144-146 doi:10.1136/inpract.28.3.144

Clinical Practice Companion Animal Practice: Getting results in clinical pathology 1. Pros and cons of in‐clinic biochemical testing

Mark Pinches

In Practice 2006;28:2 80-83 doi:10.1136/inpract.28.2.80

Biochemical analyser: Toy or tool? In Practice 1992;14:4 210 doi:10.1136/inpract.14.4.210

Cost-Effectiveness Biochemical analyser: Toy or tool?

Stephen Ware

In Practice 1992;14:3 154-155 doi:10.1136/inpract.14.3.154

Mail Bag Biochemical analyser: Toy or tool?

John P. Sauvage

In Practice 1992;14:5 274 doi:10.1136/inpract.14.5.274-a

Those old guys - who'd have thought they coudl have thought like this all that time ago?

JGW

Re: Iddexx Vettest

Evelyn Barbour-Hill — Thu, 04 Oct 2012 15:14:14 GMT

[quote user="Gillian Mostyn"]But that is just me! [/quote]

It is also I.

Re: Iddexx Vettest

Bob Russell — Thu, 04 Oct 2012 15:07:39 GMT

If the 'older and cheaper' machines use 'new and fresh' rotas then the results are just as good as a 'new and expensive' machine running the same rotas!

'Newer and significantly better' is what I am interested in!

If the technology is poor (dry slide argument) it is a completely different argument and I admit I would not like to return to our old Iddexx set up through choice but many practices are happy with them!

Re: Iddexx Vettest

Gillian Mostyn — Thu, 04 Oct 2012 14:18:44 GMT

[quote user="patrick murphy"]I cannot get your objections to ancient second machines, that are there only to help. [/quote]

I hope I understood your meaning correctly, that these machines are better than nothing?

If the blood work wasn't being charged, I would agree with you. But when clients are paying a lot of money (£60 is a lot of money, afterall) for a substandard service, then I do feel a better alternative would be to use an external lab.

I should say, if I could afford the whizz-bang bells and whistles machines then I'd love to have them here. But I can't - the individual tests would need to be so expensive as to be out of an average client's reach. (we run up to 4 or so bloods a day, max). I will not increase the blood letting - those that need bloods doing are already getting them. Therefore the best option for me to retain reliability and quality in my sampling is to send them to an external lab. I wouldn't just get an old cheaper machine and settle for lower quality results than what could be achieved, with the same cost to the client.

But that is just me!

Re: Iddexx Vettest

patrick murphy — Thu, 04 Oct 2012 12:52:32 GMT

no, the gp's take the samples and may call you back in 3 weeks,or if lost (true) not bother at all.I cannot get your objections to ancient second machines, that are there only to help.

Re: Iddexx Vettest

Bob Russell — Wed, 03 Oct 2012 18:08:27 GMT

We very rarely push 'pre-anaesthetic' bloods on safety grounds. As pets age I am happy to have blood test results to refer back to.

We don't have a massive throughput on our machines but they still earn their keep!

Our HM 5 gives very good figures compared to the external lab and we regularly run both as the cost to us per test is peanuts for the HM but I will often send slides (and samples) away for complete haematology.

We had the older HM3 machine and that was guesswork to some extent but the newer model is far more reliable!

Re: Iddexx Vettest

Gillian Mostyn — Wed, 03 Oct 2012 17:08:35 GMT

[quote user="David Mills"]

You're getting ahead of yourself. No-one has intimated that a decent practice needs these facilities.

[/quote]

Sorry, I didn't mean anyone here did say that. I just think it is a shame that it has become'the norm' to be expected torunin-house bloods, even when this isn't necessarily in the best interests of the practice or its clients.

Does the PSS make it a stipulation for registration at all? Just curious.

Re: Iddexx Vettest

Evelyn Barbour-Hill — Wed, 03 Oct 2012 17:05:02 GMT

[quote user="Gillian Mostyn"]Renal failure is always cited as the reason for having in-house bloods, but, as you say, a good clinical exam plus a urine specific gravity is pretty conclusive![/quote]

Indeed. And the strip test for Blood urea Nitrogen may not be terribly accurate but it will certainly give you a good enough guide.

Haematology? Hmm. I'm not aware of any machine that can examine a smear for a proper differential count.

[quote user="Gillian Mostyn"]

We've had this conversation before, but bloods are very rarely urgent and clients don't expect instant results - they are impressed with a 24hr turnaround! The idea that all practices should do bloods internally to be a decent practice is wrong. Even GPs and hospitals send their bloods to a proper lab - they don't run them 'round the back' on an ancient second hand machine. And charge the client a fortune for the priviledge.

Sorry - a bug bear of mine......

[/quote]

I agree with you, Gillian.

Re: Iddexx Vettest

Gillian Mostyn — Wed, 03 Oct 2012 17:04:50 GMT

[quote user="David Mills"]With all due respect, I've given you an outline of what the cost is to us based on yearly usage including everything; then you say you disbelieve it.[/quote]

Because you haven't included any capital costs or machine rental

Re: Iddexx Vettest

David Mills — Wed, 03 Oct 2012 17:01:45 GMT

[quote user="Gillian Mostyn"]

have youfactored in any labour costs?

[/quote]

Yes, they're almost zero - and more than covered by the blood sampling fee.

[quote user="Gillian Mostyn"]

Because I think your original 'cost' calculation is far too low, I'd have to disagree with the mark-up comment above.

[/quote]

With all due respect, I've given you an outline of what the cost is to us based on yearly usage including everything; then you say you disbelieve it. Peculiar why you asked in the first place?

[quote user="Gillian Mostyn"]

I'd have to disagree with the mark-up comment above.

...

with a reasonable interpretation fee, is likely to be just as,

...

if not more, profitable. And certainly a lot less hassle.

[/quote]

OK. Last PP I worked at put £20 on top of every lab fee not incl VAT. On a basic £25 profile without interpretation not incl VAT (NW labs i think) that's quite a lot (this may not be the same mark up most businesses use, I admit) to the client - about £53. You can reduce this by c.£10 for the client with an in-house blood machine - same profit margin but lower client cost. Or simply keep the same prices and increase margin.

The hassle argument is a fallacy. It's less hassle to use a vetscan than package bloods.

[quote user="Gillian Mostyn"]

The idea that all practices should do bloods internally to be a decent practice is wrong. .

[/quote]

You're getting ahead of yourself. No-one has intimated that a decent practice needs these facilities.

Re: Iddexx Vettest

Gillian Mostyn — Wed, 03 Oct 2012 16:56:43 GMT

[quote user="Bob Russell"]I am happy to have a balance between the options of in-house and external facilities.[/quote]

Fair enough, but don't most in-house systems only become affordable with frequent use? Therefore you will preferentially use the machine rather than external labs (or, even worse, use it when there is no clinical indication, such as pre-op bloods on young healthy animals ) just to make it pay for itself?

Re: Iddexx Vettest

Bob Russell — Wed, 03 Oct 2012 16:47:40 GMT

I admit to not being a great fan of the Vettest machine, not least because the technology is sold on the grounds of reproducibility not quality of results but it still has its place!

I am happy to have a balance between the options of in-house and external facilities.

Re: Iddexx Vettest

Gillian Mostyn — Wed, 03 Oct 2012 16:41:23 GMT

[quote user="Bob Russell"]If that ancient second hand machine gives good, reliable results then age is irrelevant.[/quote]

Kind-of, but age inevitably leads to some deterioration of function and also using 'old' technology. As you say, regular quality control will overcome this problem but, honestly, how many practices do this? Most external labs will be checked frequently, in-house machines are lucky to get serviced annually!!!

Renal failure is always cited as the reason for having in-house bloods, but, as you say, a good clinical exam plus a urine specific gravity is pretty conclusive!

Re: Iddexx Vettest

Bob Russell — Wed, 03 Oct 2012 16:38:08 GMT

Ours take minutes (seconds for haematology) and anyone can run them including non-clinical staff and vets!

Re: Iddexx Vettest

Gillian Mostyn — Wed, 03 Oct 2012 16:35:19 GMT

[quote user="Mark Holmes"] I would think though that labour costs packaging and posting bloods or running a machine are similar.[/quote]

TBH I haven't used an in-house set-up for some time but in my experience they sucked up vast amounts of nurse time! Maybe they are more efficient and reliable these days.