ABSTRACT
Medical laboratories in France have always adapted to technical and medical progress, as well as to the regulations imposed by the supervisory authorities. However, over the last ten years, this evolution has been so important that biologists are witnessing a revolution in their mode of practice. The supervisory authorities wanted to increase and harmonize the quality of laboratory results. But the new legislation, sometimes misused, as well as the fear and the cost of accreditation, are at the origin of the excessive acceleration of the financialization of medical biology laboratories. We will see how the hegemony of financial groups can be detrimental to the quality of service provided to patients and to the independence of the medical biologist.
Les laboratoires de biologie médicale en France se sont toujours adaptés aux progrès techniques et médicaux, ainsi qu'à la réglementation imposée par des autorités de tutelle. Mais, depuis une dizaine d'années, cette évolution est si importante que les biologistes assistent à une révolution de leur mode d'exercice. Les autorités de tutelle ont souhaité accroître et harmoniser la qualité des résultats des laboratoires. Mais la nouvelle législation, parfois détournée, ainsi que la peur et le coût de l'accréditation, sont à l'origine de l'accélération démesurée de la financiarisation des laboratoires de biologie médicale. Nous verrons comment l'hégémonie des groupements financiers peut nuire à la qualité du service rendu aux patients et à l'indépendance du biologiste médical.
Subject(s)
Laboratories , Public Health , Humans , Hospital Units , Accreditation , FranceABSTRACT
Medical biology is an essential part of patient care, both for the diagnosis and monitoring of diseases and for certain therapeutic advances. However, in recent years, it has been confronted with fundamental questions concerning its future. This report is the follow-up to the one published in 2018 by the National Academies of Medicine and Pharmacy and unfortunately only confirms a strong deterioration at all levels. The public authorities do not assume their role of regulator, thus allowing the excessive financialization of Medical Biology to grow considerably and lead to disproportionate groupings of Medical Biology Laboratories (MBL), destructive and sources of health risks. The result is that the Medical Biology Laboratories in towns, which are already known to be poorly distributed, are gradually becoming simple sampling sites, with patients finding themselves alone, often anxious, with their results sent to them by Internet without interpretation. Moreover, although progress in the field of Medical Biology is incredible and should constitute a major pole of attraction for young people, the disaffection of the discipline is total and worrying. Finally, innovation, in the context of current technological progress: connected devices, artificial intelligence and big data, represents a major challenge for the future. Here again, little or nothing is being done, even though the challenges are immense. After these alarming observations, the report will end with a series of recommendations aimed at optimizing the entry of MBL into a new era.
La biologie médicale est un maillon essentiel de la prise en charge des patients, tant pour le diagnostic et le suivi des maladies que pour certaines avancées thérapeutiques. Elle est toutefois, depuis quelques années, confrontée à des questions fondamentales concernant son avenir. Le présent rapport s'inscrit dans le prolongement de celui publié en 2018 par les Académies nationales de médecine et de pharmacie et ne fait malheureusement que conforter une forte dégradation à tous les niveaux. Les pouvoirs publics n'assument pas leur rôle de régulateur, permettant ainsi que la financiarisation à outrance de la biologie médicale s'amplifie considérablement et conduise à des regroupements démesurés des laboratoires de biologie médicale (LBM), destructeurs et sources de risques sanitaires. Le résultat est que les LBM de ville, dont on connaît déjà la mauvaise répartition territoriale, deviennent progressivement de simples sites de prélèvements, les patients se retrouvant alors seuls, souvent angoissés, avec leurs résultats transmis par Internet sans interprétation. Par ailleurs, bien que les progrès dans le domaine de la biologie médicale soient incroyables et devraient constituer un pôle d'attractivité majeur pour les jeunes, la désaffection de la discipline est totale et inquiétante. Enfin, l'innovation, dans le cadre des progrès technologiques actuels : dispositifs connectés, intelligence artificielle et mégadonnées (big data), représente un enjeu majeur pour l'avenir. Là encore rien n'est fait, ou presque, alors que les chantiers sont immenses. Après ces constatations alarmantes, le rapport se terminera par une série de recommandations visant à optimiser l'entrée des LBM dans une nouvelle ère.
Subject(s)
Artificial Intelligence , Biology , Humans , Adolescent , France/epidemiologySubject(s)
Automation, Laboratory , Cytodiagnosis , Hematologic Tests , Hematology/standards , Practice Guidelines as Topic , Automation, Laboratory/instrumentation , Automation, Laboratory/methods , Automation, Laboratory/standards , Cytodiagnosis/instrumentation , Cytodiagnosis/methods , Cytodiagnosis/standards , Hematologic Tests/instrumentation , Hematologic Tests/methods , Hematologic Tests/standards , Hematology/instrumentation , Hematology/methods , Hematology/trends , Humans , Medical Laboratory Personnel/standards , Practice Guidelines as Topic/standards , Robotics/standards , Societies, Scientific/organization & administration , Societies, Scientific/standards , Societies, Scientific/trendsABSTRACT
The SFBC Working Group on critical care testing describes in this paper the SFBC recommendations for the determination of maximal turnaround times (TAT) for laboratory medicine examination in emergency conditions. The table presented in a previous paper was updated, taken into account the clinical situations, as well as the emergency response capabilities of the medical laboratory. These new French recommendations must to be based to each local situation in a clinical-biological context between the physicians and the specialist in Lab Medicine.
Subject(s)
Critical Care , Medical Laboratory Science/standards , Point-of-Care Testing/standards , Professional Practice/standards , Accreditation , Critical Care/classification , Critical Care/methods , Critical Care/organization & administration , Critical Care/standards , Emergencies/classification , France , Humans , Medical Laboratory Science/organization & administration , Societies, Medical/standardsSubject(s)
Clinical Laboratory Information Systems , Clinical Laboratory Techniques/trends , Research Report/trends , Accreditation/trends , Clinical Laboratory Information Systems/organization & administration , Clinical Laboratory Information Systems/standards , Clinical Laboratory Information Systems/trends , Clinical Laboratory Techniques/standards , Diagnostic Tests, Routine/standards , Diagnostic Tests, Routine/trends , Humans , Organizational Innovation , Research Report/standardsABSTRACT
SFBC working group on critical care testing describes in this paper guideline for the management of laboratory medicine examination process in emergency conditions. After a summary on French standards and regulations, the critical care testing perimeter and definitions of stat levels are presented in different contexts. The complete examination process is described. Guidelines are proposed for each step, to manage sub-process in a risk management approach. The following steps were studied: ordering (by specialties), sampling, transport, reception, analysis, validation and release. In summary, we proposed a list of examinations allowed to be prescribed in stat conditions with a short list and complementary tests as a function of clinical setting. These guidelines need to be adapted in clinicobiological contracts.
