2006 OPEN FORUM Abstracts
IMPROVING ARTERIAL BLOOD GAS TURN-AROUND TIME IN THE EMERGENCY DEPARTMENT.
Rebecca
Meredith, RRT, BS, Barbara Morgan, RN, MSN
The
Cleveland
Clinic,
Cleveland
Ohio
.
Background: Arterial blood gases are an essential
laboratory parameter required to effectively manage patients in the emergency
department. As our patient volume and acuity increased, availability of results
in a timely manner became problematic. The issue was addressed at our Quality
Management and Emergency Department Leadership meetings. Baseline turn-around
times were often greater than 30 minutes. Lengthy turn-around times (TAT)
increased time to therapeutic intervention which could potentially worsen the
patient's clinical condition, delay transport to an intensive care unit, and
take the therapist away from the bedside of critically ill patients to
follow-up with the laboratory via telephone. The team brainstormed possible
causes of prolonged turn-around time which included improper specimen labeling;
critical values not being reported; lost, destroyed, or clotted samples;
printer not working; and waiting for carriers to send the specimen to the
lab. In addition, the sample had to make
two stops: first central lab, then acute care lab.
Method: The prolonged
TAT was discussed with laboratory personnel and possible interventions included
having lab supervisor carry a pager specifically for problems in the ED and
placing lab requisitions for ABG's on purple paper to
identify a "stat" specimen. The ED continued to monitor the TAT for an additional
three months, but the interventions did not change the TAT, it remained at 33
minutes. The team now looked at comparative models that were already
established in the neonatal and pediatric intensive care units and performed a
cost analysis of cartridge vs non-cartridge based
systems. The emergency department has a team respiratory therapists who are
qualified to maintain and run a moderately complex point-of-care testing
system. With this in mind, the decision was made to decentralize the process to
the emergency department with the purchase of a bench top, non-cartridge based
analyzer. The program proposal form for the
decentralization of a moderately complex point-of-care test was
completed along with the instrument/method validation studies, competency
testing, staff training, and written technical procedures.
Results: The
first five months of data revealed an average turn-around time of three
minutes; an 89% decrease. All of the
variables associated with the sample leaving the department to be analyzed were
eliminated. Of the first 664 samples
there were 10 that did not have critical values appropriately reported to the
physician. Addition of a physician pick
list as a mandatory field eliminated this problem for future samples.
Conclusion: Decentralizing an arterial blood gas machine
has improved quality of care and patient safety by expediting time to
therapeutic intervention, improving throughput, and allowing for more timely
disposition.