QA Monitoring

Kelly:

I apologize if you get this twice.  I wasn't sure if the first one posted or not.

• We monitor K, Lactic, BNP and Troponin.


• Target is result within 60 minutes (receive to result).


• The last report I saw was for Troponin at one of our satellite hospitals.  98% of troponins reported within the 60 minute target with the mean time being 29 minutes (receive to result).


• No STAT Lab in our ER's.  The STAT lab at the main hospital was closed years ago and we have been adding POC testing ever since that time.


• Approx. 110 ER beds at the main hospital where I am located.


• Per 2016 GHS Report to the Community, we had 267,019 ER visits.  (approx. 26,000 of those were pediatrics.)


• ER POC tests here at the main hospital - urine dipsticks, urine pregnancy, Rapid Strep, Rapid Flu, RSV (Peds only), glucometer, I-STAT Troponin, I-STAT Lactate, I-STAT Creatinine, eye pH, Occult blood by provider only for stool and gastric.


• Interfaced POC tests - urine dipstick, I-STAT and glucometer.


• POC performed by nursing staff, RNs and NSTs (Nursing Specialty Techs). 


• Phlebotomy is somewhat decentralized for the house - all critical care areas collect their own specimens (CCU, ICU, ER) while phlebotomy draws all other areas.


• STATs are sent by tube system as they are drawn.

Good luck!

    Sonya Evans, MT(ASCP)

    POC Coordinator

    Greenville Health System

    Greenville, SC

    sevans@ghs.org, 864-455-4494

Thank You Sonya!!

Kelly,

Great questions!  Similar to most organizations, POC testing and requests for new POC testing in our EDs continues to grow.  While most locations monitor TAT for POC tests and even for certain tests performed in lab, I am always very interested to know if anyone can actually statistically correlate these decreased TATs to actual ED throughput.  I realize many of these tests also help triage the next level of care needed but I also consistently see very fast test results but no real direct correlation to patient throughput. 

We have sophisticated throughput tracking boards but so far, we can't really correlate rapid POC results to actual throughput.  I would love to hear from facilities who have been able to show the impact POC (which analytes) can make on patient throughput.

Thanks,

Kelly Lucas

National Director Clinical Operations Improvement

Tenet Healthcare

Tracking TAT to ED throughput is usually outside the purview of the POCC.  Most of us do not have accesses to the data analytics outside of our own programs.  It is a great idea, but would need to be driven by an interdisciplinary QM team.

I am working on putting together an interdisciplinary round table to discuss how to make changes that would be both practical and effective.

While currently we are working to find a middle ground regarding reasonable and achievable TAT's, I would love to ultimately correlate these changes to ED throughput.

Any suggestions or input, is always appreciated.

Thank You Again,

Kelly