The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

A COMPARISON OF CORRELATIONAND TURNAROUND TIMES OF CBC PERFORMED BY RESPIRATORY CARE PRACTITIONERS UTILIZINGA POINT OF CARE TESTING DEVICE (COULTER® ACT DIFF2) TO A CLINICAL LABORATORYDEVICE (BECKMAN GENS).

Stanley M. Baldwin,MBA, RRT, Elizabeth Fischer, RPFT, Daniel G. Walters, M.D., Jonathan Mack,NP, MSN, Glen Grayman, M.D., Departments of Pulmonary and Emergency Services,Desert Regional Medical Center, Palm Springs, CA.

Background: Press-Ganey datashows a strong correlation between patient dissatisfaction and longer emergencydepartment waiting times. Desert Regional Medical Center (DRMC) employed andparticipated in Health Works consulting consortium with an advisory board fromWashington, D.C. Their findings identified several bottlenecks, one being laboratoryturnaround. DRMC?s actual lab turnaround time (TAT) was on average 62 minutesfrom order to receipt availability in the ED. Health Works identified that laboratoryturnaround could be considered ?strong? performance if TAT was 30 minutes orless. To reduce response times, a Beckman Coulter® AcT Diff2 was purchased,capable of a three-part differential and placed in the lab in the emergencydepartment. This device is classified as moderate complex, allowing testingto be done by respiratory care practitioners. All respiratory therapists weregiven an eight-hour intensive course on physiology and the CBC Hematology Analyzerfrom the clinical lab with testing for competency. Therapists were trained atthe machine site by direct demonstration and observation. Reportable rangeswere determined and guidelines set for out of range analysis to be forwardedto the clinical laboratory. The ED lab analyzer was connected to a central informationrepository via the Cerner Information System. This facilitated computer chargesand data from the lab in ED being integrated with clinical laboratory reportsunder a special heading titled Pulmonary and ED Lab.

Methods: 37 turnaround timesfrom draw time to availability by computer to the emergency room physicianswere selected using a table of random numbers. Correlation between AcT Diff2in the ED Lab and Gen*S in the clinical laboratory was done by parallel studyof 36 whole samples. Regression analysis was performed on WBC?s, RBC?s, HGB,HCT and platelets to determine correlation coefficients.

AcT Diff2WBCRBCHGBHCTPLT
Mean 9.9 3.7111.534.0 235

Gen*S

WBCRBCHGBHCTPLT

Mean

9.8 3.67 11.634.0228
WBCRBCHGBHCTPLT
Mean Difference 0.10.04-0.1 0.0 7

Regression Analysis (rvalue)

0.9970.988 0.9940.988 0.997
ED LabClinical

Turnaround Time

14

62

Results: The correlation betweenthe devices was high with r being greater than 0.95 on all analytes. The turnaroundtime for the ED Lab was 14 minutes vs. the Clinical Lab of 62 minutes. Thisexceeded Health Works benchmark of 30 minutes for strong performance by 16 minutes.

Conclusion: The use of a pointof care device for CBC analysis by trained respiratory care practitioners canreduce turnaround time to physicians improving both efficiency and customersatisfaction while maintaining quality laboratory standards.

OF-01-234

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