The Science Journal of the American Association for Respiratory Care

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.

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