Pregnancy, INR, Fingersticks

[Pain Applicant1]

What's the final word:

1. INR: In house or send to lab?
It's hard to make the financial numbers work on INR testing in-house but very inconvenient for patient to go to lab. Is a CLIA waiver necessary for all testing?

2. Pregnancy: Do you need to have a consent form signed prior to pregnancy testing? Is a CLIA waiver necessary for all testing?

3. Fingerstick: In house or send to lab? It's hard to make the financial numbers work for testing in-house but very inconvenient for patient to go to lab. Is a CLIA waiver necessary for all testing?

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[lobelsteve]

We have an in house COLA lab.
And we also have fingerstick testing for convenience.
The lab comes to my procedure suite or pre-op to test.

 

[facets]

we are small-as in Im it. You need clia for anything, pg test, inr, bs. We do it in house for pt convience. All diabetes get bs before steroid injections, any female under 45 a pg test, inr after they have been off coumadin 3-5 days, u should have urine test strips also, Ever get thoses weird back pains that just dont add up, no fever, no pain with movement? check the urine. Esp in woman,bladder pain refers to the low back. Dont want to be doing facet injections for cystitis

 

[Pain Applicant1]

Thanks a lot for the very helpful advice. I guess I'll make the investment and bring it all in house for pt convenience. I think it might be a money loser but I guess it's worth it for convenience.

we are small-as in Im it.

 

[bedrock]

Thanks a lot for the very helpful advice. I guess I'll make the investment and bring it all in house for pt convenience. I think it might be a money loser but I guess it's worth it for convenience.

How far away are you from a lab? I'm fortunate there's a lab 300 yards from my office, so I just send everything out. But I'm not sure it would be an issue if the lab was 15 miles away.
Patient's have their INR, bHCG checked within 24 hrs of procedure, no issues. Many labs are open into the evening. I would check your area. There may be someplace they could be checked the evening before their procedure.

When I initially consult a diabetic, I check their most recent BS/HBA1c testing, but don't require them to check their BS before an epidural, unless they are a trainwreck diabetic.

 

[facets]

the lab is 10 miles away, and a lot of people "forget" which leads to cancellations. If u shop around u can get pg tests for a dollar

 

[Jcm800]

the lab is 10 miles away, and a lot of people "forget" which leads to cancellations. If u shop around u can get pg tests for a dollar

Preg tests are cheap, as is the blood sugar monitoring, but we could not make the INR make financial sense for us. Just to pricey for the volume.

 

[PMR 4 MSK]

All diabetes get bs before steroid injections, any female under 45 a pg test, inr after they have been off coumadin 3-5 days

I would consider raising the preg test age to at least 50, excepting cases of hysterectomy, bilateral oophorectomy or tubal ligation.

What do you do with the BS test results? Say you have a type 2 diabetic with a BS of 192? or 341?

 

[Pain Applicant1]

I cut back on the steroid a bit if under 200. Over 200 I've been rescheduling. Not sure what it's based on other than the way I've been trained.

 

[Pain Applicant1]

How far away are you from a lab? I'm fortunate there's a lab 300 yards from my office, so I just send everything out. But I'm not sure it would be an issue if the lab was 15 miles away.
Patient's have their INR, bHCG checked within 24 hrs of procedure, no issues. Many labs are open into the evening. I would check your area. There may be someplace they could be checked the evening before their procedure.

When I initially consult a diabetic, I check their most recent BS/HBA1c testing, but don't require them to check their BS before an epidural, unless they are a trainwreck diabetic.

I think that's a good policy and would be much easier for me. I'm right next to the hospital but it's still an extra trip for the patient. I'll assume that some of my patient's will probably forget.