Emergency severity level-3 patient flow based on point-of-care testing improves patient outcomes.

BACKGROUND: Overcrowding of the Emergency Department is rapidly becoming a global challenge and a major source of concern for emergency physicians. The desire to improve Emergency Department throughput requires novel approaches to patient flow. MATERIALS AND METHODS: We conducted a prospective and cluster-randomized study, to evaluate the impact in patient outcomes of a new patient flow based on Point-of-Care Testing (POCT). A total of 380 Emergency Severity Level-3 patients were enrolled and studied in two different groups, interventional arm (laboratory analyses performed on POCT analyzers implemented in the Emergency Department) or control arm (central laboratory). The primary outcome was the Emergency Department length of stay. Secondary outcome included the time to first medical intervention, the laboratory turnaround time and the time to disposition decision. Readmission within the 7 days after discharge was also calculated. RESULTS: Length of stay significantly decreased by 88.50 min (from 247.00 to 158.50), time to disposition decision by 89.00 min (from 192.00 to 103.00) and laboratory turnaround time by 67.11 min (from 89.84 to 22.73) in the POCT group. No increase in readmission was found. CONCLUSION: Our strategy based on POCT represents a good approach to optimize patient flow in the Emergency Department and it should be seen as a starting point for further studies focusing on improving throughput.

Evaluation of two HbA1c point-of-care analyzers.

BACKGROUND: Measurement of HbA1c is the most important parameter to assess glycemic control in diabetic patients. Different point-of-care devices for HbA1c are available. The aim of this study was to evaluate two point-of-care testing (POCT) analyzers (DCA Vantage from Siemens and Afinion from Axis-Shield). We studied the bias and precision as well as interference from carbamylated hemoglobin. METHODS: Bias of the POCT analyzers was obtained by measuring 53 blood samples from diabetic patients with a wide range of HbA1c, 4%-14% (20-130 mmol/mol), and comparing the results with those obtained by the laboratory method: HPLC HA 8160 Menarini. Precision was performed by 20 successive determinations of two samples with low 4.2% (22 mmol/mol) and high 9.5% (80 mmol/mol) HbA1c values. The possible interference from carbamylated hemoglobin was studied using 25 samples from patients with chronic renal failure. RESULTS: The means of the differences between measurements performed by each POCT analyzer and the laboratory method (95% confidence interval) were: 0.28% (p<0.005) (0.10-0.44) for DCA and 0.27% (p<0.001) (0.19-0.35) for Afinion. Correlation coefficients were: r=0.973 for DCA, and r=0.991 for Afinion. The mean bias observed by using samples from chronic renal failure patients were 0.2 (range -0.4, 0.4) for DCA and 0.2 (-0.2, 0.5) for Afinion. Imprecision results were: CV=3.1% (high HbA1c) and 2.97% (low HbA1c) for DCA, CV=1.95% (high HbA1c) and 2.66% (low HbA1c) for Afinion. CONCLUSIONS: Both POCT analyzers for HbA1c show good correlation with the laboratory method and acceptable precision.

Resultados de la implantación de un sistema de control de calidad para los glucómetros del Área Hospitalaria Virgen Macarena, con conexión on-line al Laboratorio de Bioquímica Clínica, durante el período 2003-2007 / Implementation of an on-line quality control system for glucose meters in the Virgen Macarena University Hospital Health Area

Objetivo: Implantar un sistema de control de calidad on-line en todos los glucómetros del Área Hospitalaria Virgen Macarena (2 hospitales, 3 centros de especialidades, 1 centro de diálisis y 2 centros de salud), para conseguir los objetivos analíticos recomendados por la ADA/AACC/NACB y mantenerlos por medio del seguimiento y control de todos los datos de pacientes y controles desde el Laboratorio de Bioquímica Clínica. Material y métodos: Noventa equipos de determinación de glucemia portátiles (glucómetros de uso profesional PCx de Abbott©) conectados on-line a la red informática del hospital. Los glucómetros envían todos los datos a la estación central de datos, donde quedan registrados todos los resultados de pacientes y controles de calidad, centralizado en el Departamento de Bioquímica Clínica. Previa a la implantación de los sistemas se llevó a cabo un programa de formación para el personal con responsabilidad en la monitorización de la glucemia de los pacientes del área (más de 900 profesionales de enfermería). Se emiten informes de forma periódica a los responsables de las diferentes unidades asistenciales, donde se les facilita el consumo de tiras y los resultados de los controles. Resultados: Durante 5 años (2003-2007) se han realizado más de 1.500.000 determinaciones de glucemia a pacientes y más de 140.000 determinaciones de controles de calidad, con un error medio del 6,37% (2,18-7,52) en los valores bajos de glucemia y de 5,39% (1,53-7,52) en los valores altos. Conclusiones: La responsabilidad de los resultados analíticos de la monitorización de la glucemia en los pacientes del área ha sido asumida por parte de nuestro Laboratorio de Bioquímica Clínica, y se ha basado en un control de calidad con seguimiento on-line, asý como en el esfuerzo de formación del personal. El nuevo sistema ha demostrado que los glucómetros utilizados en un área hospitalaria de 1.200 camas, que atiende a una población de 550.000 habitantes y con más de 350.000 determinaciones/año de glucosas POCT, se pueden controlar en tiempo real, consiguiendo los objetivos analíticos de la ADA/AACC/NACB, para ello ha sido fundamental la implicación del personal de enfermería, garantizando la calidad analítica de los resultados, siempre que este dirigido desde el laboratorio (Unidad POCT). © 2008 AEBM, AEFA y SEQC. Todos los derechos reservados(AU)

Objectives: To implement an on-line quality control system in the Virgen Macarena Hospital Health Area (2 hospitals, 3 specialised care centres, 1 dialisis centre and 2 primary care centres), in order to achieve the ADA/AACC/NACB recommended analytical goals, and maintain them by on-line control from the Clinical Biochemistry Laboratory. Materials and methods: 90 glucose meters (PCx from Abbott) connected on-line to the central information network of the hospital. Meters send the patient and control measurements to the Central Data Station, where they are registered. Then data are analysed in the Clinical Biochemistry laboratory. Before implementing the system, we carried out training program for personnel with responsibilities for glucose monitoring (more than 900 nurses). Periodical reports are sent to the different health care units. The report includes quality control data and the consumables used. Results: During the last 5 years more than 1,500,000 blood glucos determinations and more than 140,000 controls were measured. Mean total error of control measurements was 6.37% (2.18¿7.52) at a low glucose level and 5.39% (1.53¿7.52) at high glucose levels. Conclusions: Glucose monitoring of the patients from the Virgen Macarena University Hospital Health Area is now under the responsibility of the Clinical Biochemistry Labratory. The new system has demonstrated that the glucose meters from Specialised Care in a whole Health Area can be controled on-line, and achieving the analyical goals recommended by ADA/AACC/NACB. The success has been based on the educational program together wit the motivation of nurses(AU)

Educational intervention together with an on-line quality control program achieve recommended analytical goals for bedside blood glucose monitoring in a 1200-bed university hospital.

Portable meters for blood glucose concentrations are used at the patients bedside, as well as by patients for self-monitoring of blood glucose. Even though most devices have important technological advances that decrease operator error, the analytical goals proposed for the performance of glucose meters have been recently changed by the American Diabetes Association (ADA) to reach <5% analytical error and <7.9% total error. We studied 80 meters throughout the Virgen Macarena Hospital and we found most devices with performance error higher than 10%. The aim of the present study was to establish a new system to control portable glucose meters together with an educational program for nurses in a 1200-bed University Hospital to achieve recommended analytical goals, so that we could improve the quality of diabetes care. We used portable glucose meters connected on-line to the laboratory after an educational program for nurses with responsibilities in point-of-care testing. We evaluated the system by assessing total error of the glucometers using high- and low-level glucose control solutions. In a period of 6 months, we collected data from 5642 control samples obtained by 14 devices (Precision PCx) directly from the control program (QC manager). The average total error for the low-level glucose control (2.77 mmol/l) was 6.3% (range 5.5-7.6%), and even lower for the high-level glucose control (16.66 mmol/l), at 4.8% (range 4.1-6.5%). In conclusion, the performance of glucose meters used in our University Hospital with more than 1000 beds not only improved after the intervention, but the meters achieved the analytical goals of the suggested ADA/National Academy of Clinical Biochemistry criteria for total error (<7.9% in the range 2.77-16.66 mmol/l glucose) and optimal total error for high glucose concentrations of <5%, which will improve the quality of care of our patients.