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Cost: Benefit of Point-of-Care Blood Gas Analysis vs. Laboratory Measurement During Stabilization Prior to Transport

Published online by Cambridge University Press:  28 June 2012

Andrew J Macnab ,
Greg Grant ,
Kyle Stevens ,
Faith Gagnon ,
Robert Noble  and
Charles Sun
Andrew J Macnab*
Affiliation:
Department of Pediatrics, Children's and Women's Hospital of British Columbia
Greg Grant
Affiliation:
Department of Pediatrics, Children's and Women's Hospital of British Columbia
Kyle Stevens
Affiliation:
Division of Critical Care, Department of Medicine, St. Paul's Hospital
Faith Gagnon
Affiliation:
University of British Columbia, Vancouver, British Colombia
Robert Noble
Affiliation:
Division of Critical Care, Department of Medicine, St. Paul's Hospital
Charles Sun
Affiliation:
BC Ambulance Service, Victoria, British Colombia
*
Critical Care Research Office, L317, Children's and Women's Hospital of British Colombia, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada, E-mail: [email protected]
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Abstract

Introduction:

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 $CDN8,000); (2) Lab technician call-back (minimum two hours at $90); (3) Paramedic overtime (by the minute at $49/hour); and (4) Cost of charter aircraft wait time ($200 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 would not have been different from laboratory costs. Cost-saving on technician callback ($1,530), paramedic overtime ($690) and aircraft time waiting charges ($2,000) would have totaled ($4,220). 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.

Conclusion:

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.

Keywords

air medical transportblood gas analysischild and infantcost:ben-efitventilatorpoint-of-care testingstabilization
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 1 , March 2003 , pp. 24 - 28
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

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