The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Point-of-Care Analyzers: Are They Useful In the ICU?

Barry A Shapiro, MD Tuesday, November 5, 1996

Laboratory medicine has traditionally defined a blood analyzer as an in-vitro device that performs measurements on a blood sample that is permanently removed from the body. Blood gas analyzers have been traditionally laboratory-based. Point-of-care (POC) analyzers are now available that allow non-laboratory personnel to reliably and consistently perform blood gas measurements at or near the site of patient care. Although there is no serious debate concerning the clinical advantages of pH, PCO_{2} and PO_{2} measurements in caring for the critically ill, the frequency of measurements required for optimal care is controversial because blood gas analyzers impose three barriers to obtaining frequent serial measurements: 1) each analysis requires permanent blood loss; 2) each analysis is associated with implicit costs; and 3) availability of results involves a delay in time^{1}. Although POC analyzers significantly decrease delay in obtaining results at the bedside, they do not solve the frequency limiting factors of blood loss and cost inherently related to every blood gas analysis achieved by an in-vitro device.

Healthcare economists argue that adoption of new technology to provide an existing service must reduce the existing cost/benefit ratio for that service. Although an argument that blood gas measurements are of no benefit to patient care is without merit, data documenting improved outcomes does not exist. Therefore, potential cost savings must be demonstrated to justify adoption of POC blood gas analyzers. To avoid factors and controversies directly pertaining to the clinical laboratory, let us assume that: 1) the laboratory provides reliable and consistent blood gas data; 2) laboratory efficiency is optimal in providing blood gas analysis; and 3) the laboratory provides blood gas services at the lowest possible cost. Based upon accepted methods of cost accounting, the fiscal year 1994 Northwestern Memorial Hospital Central Blood Gas Laboratory's direct costs for each set of blood gas measurements (pH, PCO_{2}, PO_{2}, co-oximetry) was approximately $2.50, of which more than 80% was attributable to personnel costs while less than 20% was attributable to capital equipment (amortized over three years), disposable equipment, supplies and space overhead. More than five years of data collection from this laboratory demonstrates that on any given day more than 70% of blood gas samples are from patients in the ICUs or operating rooms. Applying generally accepted static accounting methods to the information available from this laboratory, it can be predicted that providing all ICU and OR blood gas measurements with POC analyzers and existing clinical personnel, the decreased payroll costs in laboratory-based personal would more than offset the increased costs of the POC analyzers. Clinical chemistry measurements commonly utilized in the ICU would obviously add value to the POC analyzers.

1. Shapiro BA: pH and blood gas measurements: discerning innovation from sophistication. Crit Care Med 1989; 17:966.

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