title: Cost: benefit of point-of-care blood gas analysis vs. laboratory measurement during stabilization prior to transport.
abstract: BACKGROUND
  This study was conducted to determine whether point-of-care testing, using the iSTAT Portable Clinical Analyzer, would reduce time at the referring hospital required to stabilize ventilated pediatric patients prior to interfacility, air-medical transport.
  
  
  METHODS
  The following data were collected prospectively: (1) When a blood gas analysis was ordered; (2) If it was necessary to call in a technician; (3) Waiting time for blood to be drawn; and (4) Waiting time for results. The cost-efficacy of point-of-care testing was calculated based on: (1) Three minutes for a transport team member to draw a sample and obtain a result using the iSTAT (unit cost 8,000 CDN dollars); (2) Lab technician call-back (minimum two hours at 90 dollars); (3) Paramedic overtime (by the minute at 49 dollars/hour); and (4) Cost of charter aircraft wait time (200 dollars per hour) for every hour beyond four hours.
  
  
  RESULTS
  Data were collected on 46 ventilated patients over a three month period. A blood gas analysis was ordered on 35 patients. Laboratory technicians were called in for 17 (49%). For 12 (34%) patients, there was a wait for the sample to be drawn, and for 23 (66%), there was a wait for results to become available. Total time waiting to obtain laboratory gases was 526 minutes compared with a calculated 105 minutes using point-of-care testing. An iSTAT cartridge cost of 420 dollars would not have been different from laboratory costs. Cost-saving on technician callback (1,530 dollars), paramedic overtime (690 dollars) and aircraft time waiting charges (2,000 dollars) would have totaled (4,220 dollars). From this study, the cost of point-of-care equipment could be recouped in 101 patients if aircraft charges apply or 192 patients if no aircraft costs are involved. For 11 cases, ventilator adjustments were made subsequently during transport, and for six patients, point-of-care testing, if in place, would have been used to optimize transport care.
  
  
  CONCLUSIONS
  The data from the present study indicate significant cost-efficacy from use of this technology to reduce stabilization times, and support the potential to improve quality of care during air medical interfacility transport.
authors.affiliation: Department of Pediatrics, Children's and Women's Hospital of British Columbia, Vancouver, Canada. amacnab@cw.bc.ca
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Macnab
authors.forename: Greg
authors.initials: G
authors.lastname: Grant
authors.forename: Kyle
authors.initials: K
authors.lastname: Stevens
authors.forename: Faith
authors.initials: F
authors.lastname: Gagnon
authors.forename: Robert
authors.initials: R
authors.lastname: Noble
authors.forename: Charles
authors.initials: C
authors.lastname: Sun
mesh_terms: D001784:Blood Gas Analysis / Q000191:economics* / Q000379:methods; D001955:British Columbia; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics*; D004638:Emergency Treatment / Q000191:economics / Q000379:methods*; D004867:Equipment Design; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D019095:Point-of-Care Systems / Q000191:economics*; D011446:Prospective Studies; D013996:Time and Motion Studies; D014187:Transportation of Patients