i-STAT in the ED

How many staff are trained? - approx. 80

Which staff is trained--RN, EMT, NT ED tech--do you allow PRN staff  - usually no on casual pool/PRN staff, all but EMT are trained

Do you set a competency number for testing---ex. do you require x number of tests per time period - one patient sample and 1 QC per period

Who does your initial training? Do you allow RN's to be TC's and do competency? Not for initial.  6-month yes, 1 yr - usually no.

How many istats do you have? 2 mod complex per ED

What is your monthly istat volume  - for ED only, approx. 500/month

Thanks James, what is your time period to do a patient and QC? What is your 1 QC--liquid or simulator?

Kim

How many staff are trained? - 77

Which staff is trained--RN, EMT, NT ED tech--do you allow PRN staff  - RN's only

Do you set a competency number for testing---ex. do you require x number of tests per time period - competency include an online course and test passed with 80% then a super user observes running of patient specimen.  This is done yearly by anyone wanting to use the devices.   Super users are RN's and department educators trained specifically by the POCC for the purpose of training staff.

Who does your initial training? Do you allow RN's to be TC's and do competency? Initial training  Initial training is done by department educators, house supervisors, POCC, or Super-users.  Initial training good for 6 months then User retakes education course, takes a written test, and is observed again.  Then the same process is repeated every year to prove competency.

How many istats do you have? We have 5 wireless iStats in our ED where CHEM8, CG8, CG4, and a random ACT-K is used.

What is your monthly istat volume  - for ED only, approx. 500/month.  Istat volume as a whole facility is anywhere from 1000+ to 2500+ depending on the month

Hi Kim, I will answer for our main hospital, which is a pediatric Level 1 Trauma center. We also have 6 smaller free standing ED's and the same would be true as below other than their volumes.

How many staff are trained? 130

Which staff is trained--RN, EMT, NT ED tech--do you allow PRN staff: MD, RN, CMT, EMT, (RN traveler and float pool by request only - some take long assignments).

Do you set a competency number for testing---ex. do you require x number of tests per time period 1 patient and 1 QC per period

Who does your initial training? Either POCC or RN Site Trainer

Do you allow RN's to be TC's and do competency? Yes

How many istats do you have? 3 in ED, 6 for FFL

What is your monthly istat volume Pretty low - only about 150 - 200 cartridges per month

Same time period as competency assessment is due - initial, 6-month, annual.  Since there's a direct observation requirement anyway, I'm accomplishing 2 things.

For mod complex, I insist on 1 liquid QC per period.  I do not for waived-only depts. - simulator is OK. 

I will add, that iSTAT is not widely used in our ED, but it is very widely used everywhere else in our organization. Our facility performs about 5,000 iSTAT cartridges per month (CG8+, CG4+, G3+, CHEM8+, and ACTk). I think it is a peds thing, where our ED is filled with kids that are not needing anything on the iSTAT, but with that said, our in-lab STAT TAT is only 12 minutes for CBC and 30 minutes for comp metabolic, so they are getting pretty fast service from the core lab. iSTAT is our primary blood gas analyzer, and 90% are performed POC.

To all, 

ISTAT through 5 hospitals-soon to be 6.

How many staff are trained? About 40-80 per ER depending on bed number probably about 250 total in ER. 

Staff that are trained? Anyone they want. PRN and agency are trained if the director sends them to class. That is the directors call. We do not have EMT. 

Initial training? Me or one other part time POCC

Set Comp number for testing? For 6 month and yearly comp they do fake blood with an Expert. For the yearly, they take a test which they must receive 100% upon. I have comp dates set twice per year.

We have been using the ISTAT since 1996. We require no set number for comps per pathologist. We tried it and it was a mess. I take a look at those that have not done a test in 6 weeks and they are almost always PRN. With those people the experts are told “ Get them or they come out.” Usually they come out. 

Do I allow RN to be TC? Yes with a BS and two years of experience with the ISTAT. I give clinical ladder points for POCT. This can mean as much as 10% more in their paychecks, so my experts are pretty stable.  I have 4 of 5 ER I do nothing but remind them, send lists to them and fake blood to them. Fake blood we track K. Usually old QC and PT all combined into a urine tube. We do 10 replicates and do the stats.

Experts must attend a class with me and teach me the checklist I use. The experts do not have to fill out the checklist per person.

How many ISTAT? 2 in 4 of 5 ED 1 in the 5th ED.

Cartridge volume? A lot. We do about 35K per year in 5 ER. CHEM8 and CG4.

We also use ISTAT as our blood gas instrument for 4 of the 5 hospitals....soon to be 5 of 5. RT uses the same process as above but trains their own people. They use strictly QC for blind samples. They have about 200 people currently. 

Deanna Bogner 210-788-0121

Thank you everyone for your comments, I love to hear how others accomplish our same goals. Our volumes are higher than most have commented, ED #1 does 5,000 istats per month with 7 analyzers and 39 staffers trained.  ED#2 does 2,600 per month, 4 istats, 38 staff, and ED #3 does 450-500 istats per month, 2 analyzers and 65 staff. ED1&2 use a model where POC has a designated space in the ED and samples are dropped off to be run by on the trained staff working in the "POC lab" which are NT's and ED techs. ED#3 uses RN, NT and ED tech. Multiple staff are trained because of their low volume and not enough to have a dedicated POC lab. I find at this site that 31 people out of the 65 do 80% of the testing.  Our theory has been to have a dedicated number of staff to run POC testing (they are also doing upregs and occult bloods along with i-STAT). I cringe when i hear "I haven't done one of these since I saw you last" year!  I want quality results and have a hard time thinking 200 people in the ED with the ability to run POC is going to equal quality work.  Nursing theory is that everyone should be trained. POC (3.5 FTE's) trains and recerts all staff system wide for moderate testing. We have about 1000 staff trained for istat alone. 

Kim, 

Our system did away with a dedicated POC space in the early 2000’s. We “encourage “ I.E.: teach that the ISTAT sample should be drawn from the IV and done in that manner....we avoid placing it in a tube. 

I too have heard, “ Gosh, I haven’t done this since I have seen you last year.” When that happens, nursing is contacted. “This is the volume, these are the people who have not run it, so you probably do not need all of these people.” They can’t argue with numbers. 

I agree that the knee jerk reaction of nursing is “Everyone shall do everything.” I understand because this makes their staffing easier. But...practice does make perfect.

i have eliminated over half of the ICU staff that does ACT testing in the manner above. 

From the side of nursing, the ISTAT has been around for a long time. We have used it since the early 1990’s. It is pretty simple to use, even without practice and will not allow result if errors are made with cartridge filling etc. 

It is a very tricky balance.....good luck with finding it for your institution.

Deanna Bogner.