Point-of-care labs are transforming hospital care and reducing overall costs
By Jerry Zeidenberg
Point-of-care technology for lab testing has come a long way, but there's still a fair bit of resistance to it in North American hospitals. That's due to a lagging perception that POC testing is more expensive than traditional benchtop testing – it no longer is, when all factors involved are considered. The hesitation is also a matter of ingrained habits – in many cases, people don't like to change their ways.
"My team had a really hard time letting go of printed results – but we made the decision not to have printers and I've never regretted that," says Patti DeJuilio, Clinical Director, Respiratory Care Services at Northwestern Medicine Central DuPage Hospital, outside Chicago. DeJuilio was tasked with replacing benchtop lab analyzers several years ago and made the decision – unique for the time – to go instead with point-of-care lab test devices from Siemens Healthineers.
DeJuilio gave a talk in December at St. Joseph's Healthcare, Hamilton, at a day-long conference on point-of-care lab technology, sponsored by Siemens Healthineers. She outlined how her centre became one of the first hospitals in the United States to incorporate point-of-care labs enterprise-wide, for blood gas testing, using Siemens's EPOC technology.
She noted the devices use Bluetooth to send results from the bedside directly into the hospital's EPIC information system. That initially confounded some members of the staff, who were used to print-outs.
But the direct transmission of results eliminated the need for manual transcription and reduced errors. No wonder DeJuilio doesn't regret this decision.
There have been added benefits.
Her hospital formerly used four benchtop analyzers for blood gas results, processing some 2,000 samples a day in this way. Typically, blood gas analyzers are used to determine pH, blood oxygen, carbon-dioxide, hemoglobin, electrolytes and metabolite levels. Nurses and other healthcare professionals would rush blood sample tubes from the bedside, in many cases, to a benchtop analyzer to obtain results.
The analyzer might be located far away from the patient – necessitating a dash through the hallways.
Frequently, however, the machine would be out of commission, due to the frequent need for calibration. "Now we're running through the hallways again looking for another machine," said DeJuilio.
And she's wasn't alone, she said, "In having the experience of dropping or breaking a sample and having blood drip down your hand."
After the hospital acquired nine EPOC analyzers, this mad scramble was no longer an issue. Blood gas results are obtained much faster, which is better for the patient and the hospital. Moreover, with the EPOC devices, there are no labels needed for samples, no sharps are required, and misidentification of patients rarely ever happens.
With faster results, she said, treatment can start faster – a major plus for the patient.
DeJuilio cited studies of POC devices in the emergency room which showed how faster diagnosis and treatment had led to quicker turnaround times – resulting in higher efficiencies for EDs.
Once implemented, the DuPage Hospital staff liked the POC systems better than traditional benchtop analyzers, too. And an unexpected benefit occurred with team morale during cardiac arrest incidents.
In the benchtop analyzer days, when team members were busy with different tasks to revive an MI patient, one member would typically be asked to take a blood sample to an analyzer – leaving the group for up to 10 minutes. "You don't really feel like you are part of the team when you're away for 10 minutes in that situation," said DeJuilio. But with POC labs, "it can be done right there."
When DeJuilio and her colleagues at the DuPage Hospital were mulling the purchase of POC labs, they too assumed the costs would be higher than for traditional analyzers. But when they compared three years of costs for their existing analyzers versus the projected costs of the point-of-care systems, they were pleasantly surprised to find that POC was actually less expensive.
Those costs included everything from capital costs to the ongoing expense of supplies, maintenance and training. "There was a significant cost saving in going to POC," said DeJuilio.
She is a firm believer that point-of-care technology is not only less expensive, but more effective. It's also helping her hospital deliver higher-quality care. A case in point is in the area of sepsis. "A lot of people die from sepsis, and we have to get better at treating it," said DeJuilio.
She noted that treating sepsis patients quickly is extremely important. Before the use of POC technology, she said the lab at her hospital had a hard time turning around lactate tests – a key indicator of cardiovascular compromise – in less than 30 minutes. That was holding back the rest of the care team, which had a goal of diagnosing and starting treatment of sepsis in 60 minutes.