The rise and fall of i-STAT point-of-care blood gas testing in an acute care hospital.
In response to a $350,000 laboratory budget cut and closure of an intensive care unit-based laboratory and a desire to maintain turnaround times of 10 minutes or less, a multidisciplinary group developed and implemented point-of-care (POC) testing. Only blood gases (pH, PO2, and PCO2) and ionized calcium values were deemed essential stat tests. Three commercially available POC blood gas devices were evaluated; all yielded results comparable to in-house reference methods. The 1 device with a US Food and Drug Administration-approved method for ionized calcium testing and with an existing interface for laboratory information systems was selected. Fiscal analysis predicted annual savings of approximately $225,000. POC blood gas analysis was implemented in April 1996 coincident with closure of the intensive care unit-based laboratory. Clinical laboratories and POC blood gas test volumes remained constant through August 1998; in contrast, the number of ionized calcium tests decreased dramatically after April 1996. In August 1998, clinically significant (i.e., artificial ventilation parameters would have been altered based on test results) discrepant PCO2 values were observed sporadically and noted only with patient specimens, not with commercial controls or electronic simulators. Because investigation failed to identify the cause, use of the POC device was discontinued in September 1998.
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Department of Laboratory Medicine, University of California San Francisco, USA.
Kraemer
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Hogan
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Eckman
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Siobal
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D001784:Blood Gas Analysis / Q000191:economics / Q000295:instrumentation / Q000592:standards / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D004777:Environment; D006779:Hospitals, Public; D006801:Humans; D019095:Point-of-Care Systems / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care