A surgeon group at our hospital has asked us to offer intraoperative parathyroid hormone testing to improve turnaround time. What is the key to a successful point-of-care program for the operating room? 

A:Communication, teamwork, method selection, and standardized workflows are the keys to any successful implementation. During method selection, consider the testing personnel and workflow as well as the quality of instrumentation. For example, a method that requires a lot of manual pipetting or reagent preparation will not feel comfortable to nurses. As a first step, use a workflow chart to map out who will perform each task and how long it will take. Additionally, don’t forget to consider scheduling of patient and testing personnel, reagent storage and preparation, supply ordering, and result reporting.

At our institution, we were fortunate to choose a method that is very stable and reliable so extensive troubleshooting is rarely an issue. The instrument is stored on a rolling cart with all the supplies needed for a day’s work. Cases are scheduled several Wednesdays and Fridays each month. Early in the day a registered nurse moves the cart to the sub-sterile room, performs startup tasks, and runs quality control. Patients have a baseline sample drawn and an average of two or three subsequent samples drawn during the procedure. Each time a surgeon draws a sample, a nurse is paged to perform testing. They may have three cases in a day. After the cases, all result worksheets and samples are sent to the laboratory for resulting and specimen storage.

What setbacks have you encountered?

Initially our surgery department wanted all nurses who work in that area to be trained, which resulted in a recurring problem: Months after training, a nurse would be scheduled on a case and panic because he or she had forgotten what to do. Point-of-care personnel in our lab would then receive a phone call begging someone from the lab to come run the tests. Another limitation we ran into is that nursing staff scheduled on cases would often not have time to set up and run quality control on an instrument in addition to all their other duties.

In response, we took a break and re-evaluated the whole process. Fortunately, one nurse volunteered to take ownership and helped get the unit back on track. Now only five staff members run the testing. They are all in mentor and unit leadership roles, which makes it expensive to perform intraoperative parathyroid hormone testing, but they excel at paying attention to detail even when multi-tasking. With just these five individuals performing the testing, they have become very competent on the instrument and our surgeons are happy with their testing. The only drawback is that it can be challenging during peak vacation times to ensure that cases are always covered.

How can laboratories best support surgical teams that want intraoperative parathyroid hormone testing?

At our institution, the surgery and point-of-care staff are truly a team when it comes to planning and dividing duties. Point-of-care staff complete the more technical tasks such as 90-day calibration, reagent prep, and monthly quality control review. Our office also stores bulk reagents and controls, orders inventory, and enters the results into the laboratory information system. In turn, surgery staff perform daily maintenance, quality control, and competency assessments. They notify us when cases are scheduled, and we communicate frequently about reagent and supply inventories. We are committed to the process and are proud that we have built a trusting partnership for our patients.

Yvonne Nelson, MLT (ASCP), is a point-of-care coordinator at Bronson Methodist Hospital in Kalamazoo, Michigan. She has 22 years of experience working with diverse employee groups within the hospital and has a key interest in process improvement. +Email: nelsony@bronsonhg.org