1995 OPEN FORUM Abstracts
A SURVEY OF BLOOD GAS USAGE IN AN URBAN TEACHING HOSPITAL MRICU: IMPLICATIONS FOR REDUCING UTILIZATION OF RESOURCES.
Whitney L. Schwartz, BA. RRT, the MRICU Respiratory Care Staff, Herbert Patrick, MD, Department of Respiratory Care, Thomas Jefferson University Hospital, Philadelphia, PA.
Introduction: Blood gases, whether ABG's or MVBG's, are invasive, expensive, and touted to be overused in all ICU's. We surveyed the utilization of blood gases in our MRICU over a period of 6 weeks to determine the appropriateness of the requests and to discover ways to make this resource more cost effective.
Methods: A convenient pocket sized survey form was developed to determine data on each gas requested; the form was completed by a respiratory therapist. The requesting party would be identified and asked the reason for the gas: oxygenation, ventilation, pH, metabolics, weaning, code, or a combination. The therapists were instructed not to dissuade the requesting party from requesting a gas even if the therapist felt the request was not appropriate.
Results: Approximately 400 blood gases/month are requested in the MRICU. Over the period of the survey, there were approximately 580 gases requested and 279 of these were surveyed, resulting in a sample representing 48%. The blood gases represented 92% arterial and 8% mixed venous blood gases.
Utilization of blood gases
Shift: Day Evening Night TOTAL
Residents7 17 6 30
Interns 45 4552 142
Nurses 19 24 22 65
Other20 14 842
TOTAL91 10088 279
Between day, evening, and night shifts, the number of blood gases did not vary significantly (32%, 35% and 31% respectively). Of the total blood gases, the residents ordered 30/279 (7.5%). interns ordered 142/279 (53%), nurses requested 65/279 (28%), pulmonary-critical care fellows ordered 2%, respiratory care practitioners requested 2% and multidisciplinary requests were 10%. Eighteen percent of the total blood gases were requested for oxygenation alone, despite availability of continuous oximetry. Evening shift showed an increase in the number of ABG's ordered by residents which may reflect the cross-coverage policy for evening housestaff in the MRICU.
Conclusions: This survey reveals that requests for blood gases: 1) were evenly distributed throughout each shift, 2) were requested predominately from two groups, the interns and the nurses, and, 3) were inappropriate 18% of the time due to the availability of continuous oximetry. Our survey indicates that educational efforts to reduce utilization of blood gases must span all shift while targeting both interns and nurses.