Immediacy: speed of response from the point of view of the physician.

A study has been carried out to determine the value of some standard biochemical tests in the emergency management of 209 acute medical admissions. Of the 678 emergency tests done, only 17.5 per cent showed abnormal results and of these only 12 per cent were helpful in diagnosis although 66 per cent were of value in treating the patients. The tests were most helpful in treating diabetic patients where the blood-glucose level decided insulin dosage in every patient; the pO2 and pCO2 levels were of value in acute on chronic obstructive airways disease; and the serum electrolytes were helpful in managing dehydration due to vomiting and diarrhoea. The possible reasons for the large number of useless tests carried out in diagnosis of these emergency admissions are discussed, and it is suggested that the most important way of avoiding unnecessary tests is better doctor training both before and after qualification. The place of immediacy of tests in the medical out-patient department is also considered. It is concluded that immediacy is of little value in diagnosing and treating out-patients, but would be helpful in reducing unnecessary return visits.