1998 OPEN FORUM Abstracts
IMPLEMENTING A POINT-OF-CARE BLOOD GAS TESTING SYSTEM IN A NICU.
Julie Ballard BS RRT, John Salyer BS RRT, Dave Pedersen MT (ASCP), Phil Bach PhD, Ramsey Worman CET, Sharon Froehlic RN. Respiratory Care Service, Primary Children's Medical Center, Salt Lake City, Utah.
Introduction: A year ago, our NICU satellite lab averaged 1.9 blood gases/hour. It became apparent that maintaining their infrequently used blood gas analyzer, the ABL520 (Radiometer America, Westlake OH), in the NICU Satellite Lab was not financially feasible, so an interdisciplinary team was created to evaluate ways to decrease costs without compromising care. Our NICU is a 35 bed ICU with 4754 vent days in 1997. Proposal: We designed a 6 month pilot, in which routine NICU blood gases would be sent to the main lab via a pneumatic tube transport system, and point-of-care testing using an i-STAT system (i-STAT Corp, Princeton NJ) would be available for new admits, unstable patients, or when the tube system was down. NICU's ABL520 could then be transferred to the main lab, allowing them to retire their ABL300 without additional capital expense. Phlebotomists and a limited # of RCP's would be trained to use the i-STAT. Lab would be responsible to maintain i-STAT QA controls and Respiratory Care would be responsible for their own proficiency testing. During the 6 month pilot we would track capillary tube loss or breakage while using the pneumatic tube system, # cartridges used, # of cartridge failures, and reasons for using i-STAT. Before we could begin the pilot, it was necessary to update the pneumatic tube system to increase its reliability and decrease downtime. Results: Tube system downtime was 341 hrs/yr prior to the upgrade, and 20 hrs/yr after the upgrade. Retiring the ABL300 saved us $20,480/year (cost of reagent, service contracts, QC controls and materials). We analyzed 4679 NICU blood gases during the 6 month pilot, with only 102 (2%) of them run on i-STAT. Of the i-STAT cartridges used, 47% of them were G3+ (blood gas, $4.75/each) and 53% of them were EG7 (blood gas and electrolyte, $7.00/each). There was no report of capillary tube breakage or loss during transport. There were 2 cartridge failures, both due to operator error during the first month of the pilot. A review of the unit's quality management reports yielded no episodes of pt care being effected due to a delay in blood gas results. The yearly material cost of running these i-STAT tests would be $1537 including service contracts and cartridges. Since analyzing a blood gas takes about 7 min of a therapist's time, NICU RCP's would save an additional 1067 hours/year (~ hrs/day) by sending routine blood gases to the main lab, and only performing the point-of-care testing. Personnel in the main lab handled the increased load from NICU (~1.1-1.9 blood gases/hr), by having the faster ABL520 machine. Main lab turnaround time on NICU blood gases averaged 15 minutes. Reasons for utilizing point-of-care testing were: unstable pt (72%), new admit (16%), inadequate sample volume (5%), and miscellaneous (7%). Discussion: Probably the most important factor in the success, is education on when to use i-STAT. Overutilization of i-STAT decreases cost savings due to the cost of the cartridges. Underutilization of i-STAT on critical pts decreases satisfaction and may compromise pt care. I-STAT results are available immediately through both a printout and automatic download from the receiving station to the bedside computer. I-STAT can be used on pts with an otherwise insufficient sample, as it only requires 2-3 drops of blood. We have kept the # of RCP's running i-STAT small (currently 21 RCP's or 47% of staff), due to the logistics of training and maintaining proficiency of all staff on this low volume procedure. By selectively using point-of-care testing, it is possible to cut costs, without compromising pt care.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.