Blood gas model: Core lab or POC?
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Curious to hear about what model (centralized or decentralized) for blood gas testing is in use at various hospital systems. We have both in the Lab and at point of care in the OR, NICU and Trauma
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We have both in Lab (Radiometer) and Point of Care (iSTAT) for blood gases. We usually only use iSTAT's on NICU, OR, code blue's, and Traumas.
Our main lab does not perform blood gases. They are done via epoc by RT for the house and by perfusion in the CVOR and by anesthesia tech in the main OR, all under the POCT CLIA. I've been here 30 plus yrs and the main lab has not done blood gases during that time. It has been decentalized, since around 1965, I am told.
We are exclusively POC ISTAT for blood gases.
We have 15 epocs, wireless interfaced with RALS, The RT team really likes doing cases at the bedside. OR could care less as long as it works. We keep 2 in the lab for training and as a backup. the lab manages the materials with RT support and participation. Pretty much trouble free system once everyone is up to speed. NICU sample injection takes special attention.
A mixed model in our health system. In and out of the clinical lab. Various lab testing personnel.
We are a medium-size community hospital - no full-panel blood gas testing in the main lab (just individual iCAL/pH requests), and that has been the case for 30+ years. All depts. performing blood gas are under main lab CLIA & CAP, however, with POCC (me) as technical consultant. We have Radiometer ABL825 (2, Respiratory), ABL90 (3 total, 1 mobile for Resp to do condition/code response testing + 1 in OR-Anesthesia and 1 in a remote OP surgical clinic), and also iSTATs (2, in ED only) using CG4+ cartridges. All blood gas resulting other than main lab goes through Telcor interface.
When I was with my last employer we had 17 hospitals, all doing it a little different. We went from 17 blood gas models to one, and it took about two years to get there. We determined that using bedside blood gas testing was the best practice model that we wanted to achieve, because transporting blood gas specimens is not ideal, and RT's need to make decisions at the bedside and a lot of time was wasted running back and forth to the benchtop blood gas analyzers. When we did a timing study and factored in sneaker time to our cost analysis, it was cheaper to sunset all of the Radiometers and other benchtops that were being used in some of our locations, and replace them with iSTATs. In the end, we did keep ABL90's in our open heart rooms at the three hospitals that had CVOR's because they were faster (unless you factor in troubleshooting down cartridges and calibration time), but everywhere else had iSTAT only, including the lab. Lab did Ionized Calcium and VBG only. iSTATs were in every ED, OR, ICU, NICU and RT dept. as well as on all of our Flight For Life choppers.
Now I am at a 400 bed Children's Hospital and we have moved to the same model recently - all ABG's , CBG's, most VBG's, Ica and Lactates are done bedside on the iSTAT. Some VBG's, Lactates, Ica, and all IMag's are sent to lab and run on the Nova phox. The phox has been extremely problematic lately so the lab has had to use iSTAT as their backup more often than not, as service takes weeks to come out and assist.
I have 6 hospitals. I have gone from 3 blood gas methods....then to two...got a new hospital and I am back to 3. One is the Nova PHOX. NOVA pHOX will be removed from my world as soon as the contract expires. The down time is stupendous! The other thing is, the instruments has PARTS and 9 solutions for a calibration!!!!! No cartridges...tubing, membranes etc. They also had a software security issue recently...then we could not get the patch to load.
It is NOT a POC instrument in any way shape or form. The CAP inspector that just inspected us said so also.
One of the hospitals has an ancient Siemens device that we are looking to replace. The other 4 hospitals use the ISTAT. We use G3 and/or EG7 depending on the site. ICA go to the lab. Lactates are done in the ER areas only on the ISTAT by the nurses with the gas blocked. If admitted, then lactates go to the lab. OR uses CG8 on the ISTAT.
RT does all gases here outside of the OR areas. They answer codes also.
One of the things we looked at was the ROI for the bedside model versus the traditional bench top methods. In one hospital, we could save 0.73 FTE by getting rid the bench tops and going to a POCT device like ISTAT. This amount of labor was just walking from the bedside to the instrument.
Deanna Bogner 210.297.9657