At the Bedside

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Is improving access for patients equaling loss of critical quality oversight?

Author’s note: On account of certain regional limitations of sales rights and service availability, we cannot guarantee that the services described in this article are available worldwide. Please contact your local Siemens organization to get more information. The outcomes obtained by the Siemens Healthineers customer described here were realized in the customer’s unique setting. Since there is no typical laboratory, and many variables exist, there can be no guarantee that others will achieve the same results.

Diagnostic testing traditionally performed in healthcare settings such as hospitals and reference laboratories is increasingly expanding beyond the brick-and-mortar boundaries of which we’ve grown accustomed. Today, point-of-care testing (POCT), or testing conducted outside the laboratory, is quickly evolving to help expedite patient care and clinical decision-making.

There are key benefits to the point-of-care testing approach. The first pertains to response time and its effect on patient care. Critical Stat tests can be processed more quickly, expediting patient care for emergency situations such as suspected venous thromboembolism.

Maintaining specimen integrity is another benefit—instruments are located nearby and testing is conducted almost immediately, which reduces the likelihood of processing delays that could reduce the viability of the sample.

Also, as health systems’ focus on value-based patient care continues to magnify, point-of-care testing can supplement missed or underutilized testing opportunities advantageous to patient’s chronic care outcomes, such as therapeutic drug monitoring and hemoglobin A1c testing.

Take, for example, a diabetic patient who requires quarterly hemoglobin monitoring. With POCT for HbA1c, by the time the patient leaves the doctor’s office or outpatient clinic, they may have already received their test results, consulted with their physician and received follow-up instructions to adjust their treatment, if necessary. That experience varies greatly from traditional testing, where the patient consults with a physician, goes to a collection station to have his or her blood drawn, waits longer than the duration of an office visit to receive the results—and then schedules a follow-up appointment to learn what the test results mean and how to adjust his or her treatment. The increased efficiency and on-the-spot directives ultimately increase patient satisfaction and improve patient outcomes when implemented effectively.

Further, the flexibility to grow beyond traditional healthcare settings enables point-of-care testing to root in places convenient for patients, such as satellite health clinics. The result is more accessible testing for patients who favor convenient medical care and faster results.

Faster results and improved patient satisfaction add value to health systems’ diagnostics portfolio. However, with point-of-care testing rapidly evolving—offering convenient instrumentation with smaller footprints and connectivity features that can effectively operate beyond the laboratory walls—one point of contest remains a key focus for stakeholders: Does point-of-care testing balance the quest for more timely patient results without sacrificing the quality controls that are maintained in a central lab?

More Hands on Deck

This question continues to concern laboratory leadership as healthcare facility consolidation trends upward and, with it, the number of potential instrument operators involved. While standardization aligns operators in terms of process, oversight in terms of visibility and quality controls (e.g., confirming operator certification and/or operator lock-out) are the greatest priority.

After all, effective patient outcomes rely on quality diagnostic reports. The effect of missed or incorrect diagnoses contributes not only to wasteful spending in healthcare, but also can be costly to patients in terms of quality of life and outcomes. Diagnostic testing makes up 2-3% of healthcare costs and drives nearly 70% of the decision making—that statistic places a significant responsibility on laboratorians and point-of-care testing operators to deliver quality results.1

One way to ensure quality control is through end-to-end solutions (i.e., instruments that—whether operated in the POCT setting or in the central laboratory—use the same reagents for consistency of results and, more importantly, diagnostic confidence.

However, reagent consistency is just one piece of the proverbial puzzle. Establishing and maintaining a healthy point-of-care ecosystem does not equate to extinction of central laboratory oversight. Instead, point-of-care testing should support the lab by delivering timely information—with the confidence of effective quality controls—to physicians at the most valuable touch points with patients, such as the HbA1c case above.

To achieve these controls, point-of-care manufacturers are continually introducing sophisticated connectivity systems to maximize efficiency and improve clinical outcomes through remote instrument and operator oversight.

For example, the St. James’s Hospital implemented the Siemens Healthineers RAPIDComm Data Management ecosystem approach. Whether managed by the central laboratory or a designated point-of-care coordinator, the data management system is designed to consolidate instrument oversight for a more efficient point-of-care testing approach.

As the largest teaching hospital in Ireland, St. James’s Hospital has more than 1,000 beds and manages more than 350,000 patients annually. It is a multi-facility campus with a comprehensive point-of-care testing program encompassing 2,800 employees. The point-of-care coordinator—who is associated with the central lab—did not have the budget to increase her headcount so she focused her efforts on evaluating technology offerings that could manage risk, quality control and patient results efficiently on a day-to-day basis to reduce the workload and contain her tasks within a reasonable day. After selecting and implementing the RAPIDComm system for its ease of use, she reported her ability to maintain hospital-wide quality and testing compliance with two staff members managing the entire health system’s point of care program. Further, she was able to identify and implement a 33% blood gas cost-per-test savings utilizing RAPIDComm’s reporting functionality.

Blood gas testing is also an integral part of the critical care environment at Memorial University Medical Center (MUMC), an award winning 530-bed tertiary care hospital in Savannah, Georgia.4 MUMC is a regional referral center for cardiac care, cancer care, high-risk obstetrics and neonatology. In addition, the hospital has the region’s only Level I trauma center. With multiple specialty areas to support, MUMC has a high patient workload, which creates a heavy demand for blood gas tests. The hospital identified a serious issue with its blood gas testing program—results were not reaching the people they needed to reach as fast as they should and the hospital was suffering from partial connectivity, poor information supply and significant lost billings.

A mix of analyzers were installed and interfaced with the RAPIDComm system, allowing centralized management of multiple blood gas analyzers and operators. The outcome at MUMC is that patient results from blood gas analyzers now hit their medical records, and essential data reaches key personnel in a timely manner. Further, interfaced systems help to facilitate patient identification at the bedside, upload to the electronic record upon analysis and enable automatic billing upon completion. This has assisted the hospital in meeting National Patient Safety Standards, Joint Commission, CAP and state regulations and has kept costs low.

As demonstrated by St. James’s Hospital and MUMC, point-of-care testing can co-exist with the central laboratory, maintain essential quality controls and add value to the health system. End-to-end solutions and advances in connectivity and are just two of the many ways point-of-care testing is harmonizing with the central laboratory to maximize efficiency, satisfy compliance requirements and reduce costs—and ultimately benefit patient care.


References

  1. Rohr U-P, Binder C, Dieterle T, et al. The Value of In Vitro Diagnostic Testing in Medical Practice: A Status Report. Wang Y, ed. PLoS ONE. 2016;11(3):e0149856. doi:10.1371/journal.pone.0149856.
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Peter Koerte
Peter Koerte

Peter Koerte is president, Point of Care, Siemens Healthineers.

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