In the last 3 years, we’ve been through two point-of-care instrumentation standardization projects. The first was standardizing blood gas instrumentation with a goal of moving from four types of blood gas analyzers to one. The second project was focused on streamlining instrumentation for testing Activated Clotting Time (ACT) from three types of analyzers to one. Our institution is not alone in this, with each passing year, more and more laboratorians face the challenge of standardizing POCT within their institution or across a growing healthcare system.
To achieve the goal of streamlining testing, one would have to overcome several challenges. In my opinion, the biggest challenge is identifying all the stakeholders that need to be involved in the process. This is very important because one would have to go back to the drawing board if a decision is made without all the stakeholders at the table. Another challenge is choosing an instrument that would meet the needs of every clinical area. How do you get everyone to agree on one instrument type which might not be the one they have experience operating? This means that they would have to learn how to use new instrumentation on top of everything else they had to do to provide patient care. Also, coordinating training for large numbers of personnel across the institution would have to be done in a manner as not to interfere with patient care. Additionally, a case has to be made for the cost of acquiring the new instrumentation which includes the cost of reagents and interfacing instruments to the electronic medical record (EMR) system.
To overcome these challenges, some key steps (1) can be followed:
- Forming a multidisciplinary team which includes all the identified stakeholders, department leads, and instrument operators.
- Assessing the situation to determine the needs of each clinical department, clinical and cost impact of change, and the aspects of each device (e.g. analytical performance, ease of use, pros and cons) being considered.
- Providing a recommendation of the device that best meets clinical and operational needs, and a proposal for piloting the recommendation.
- Implementing the recommendation with processes in place for monitoring and maintaining compliance and quality.
- Actively monitoring and maintaining compliance and quality.
The advantages of streamlining point-of-care instruments are manifold. Here are some advantages:
- Improved staff efficiency resulting from uniformity in practice across hospital departments. Uniformity reduces learning curves especially among staff who float between hospital departments that previously may have used different device types.
- Improved quality resulting from decreased pre-analytic errors, increased regulatory compliance, increased patient safety and improved test utilization. At our institution, observed improvement in quality was mainly due to interfacing the chosen devices to the EMR. Interfacing was finally possible because it was cheaper to interface two instruments versus four.
- Cost savings: Even though there is a cost associated with acquiring new instrumentation, overall cost savings can be achieved as a consequence of more efficient workflows for personnel, decreased supply expenses due to increased test volume, and decreased maintenance and data management costs owing to fewer vendor fees.
Though the process was long and painstaking, standardizing our POCT instrumentation resulted in many gains so yes, it is worth the challenge.