2.50
Hdl Handle:
http://hdl.handle.net/10755/162516
Type:
Presentation
Title:
Improving ED Throughput with iSTAT Point of Care Testing
Abstract:
Improving ED Throughput with iSTAT Point of Care Testing
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Burnie, Jeannie, RN, BSN, CEN
P.I. Institution Name:Bethesda North Hospital
Title:Emergency Department Staff Educator
Contact Address:10501 Montgomery Road, Cincinnati, OH, 45243, USA
Contact Telephone:513-745-1496
Co-Authors:Bonnie Sheedy, RN, BS; Pam Kotynski, M.H.A., BS, MT (ASCP)
[Annual Conference] Clinical Topic: I-STAT testing was underutilized in a Midwestern Suburban Emergency Department (ED) whose visits approach 60,000 patients per year. A multidisciplinary process improvement team was charged with determining why the testing was underutilized and to determine a method to improve usage.
The team decided that the following issues caused under usage:
1) Physicians did not order the test
2) Physicians did not trust validity of test results
3) Maintaining RN competency was a challenge
4) RN's did not encourage use of i-STAT due to concerns with cost
5) RN's believed that performing tests took too much time away from patient care
6) Available cartridges lead to repeat laboratory testing causing concerns with duplicate charging

Implementation: A project team coordinator was instrumental in assisting the team to work towards process improvement. The team decided to streamline the types of cartridges available and to focus on tests that would impact a large volume of the current ED population. To enhance i-STAT use, an order set was developed in the electronic documentation system labeled Cardiac Workup i-STAT and included a Chemistry 8 and Troponin. Laboratory management agreed to a trial of assigning a dedicated laboratory technician in the ED from 11a-11p to run the tests. The ED staff received education regarding the change in available cartridges, the order set in the electronic documentation system and the process to follow during the trial times. The physicians were educated about the process change, the stringent validation process that the laboratory used to ensure test results and the potential benefit of patient throughput. The initial goals included:

1) Increase usage of the i-STAT platform
2) Improve physician acceptance
3) Decrease workload of nursing staff
4) Rapid recognition of at risk cardiac patients

The trial was implemented over a one month period in the fall of 2007. The following parameters were measured:

1) ED patient length of stay
2) Lab turnaround time (TAT) for I-STAT chem 8 and troponin compared to central lab TAT
3) i-STAT lab TAT and time to disposition

Outcomes: The trial was an overwhelming success. Inclusion of the i-STAT order set in the electronic order sets eased order entry and cartridge use increased from 42 in July, 2007 to 2007 in December 2007. The ED disposition time improved from 2 hours 10 minutes in July 2007 to 1 hour and 11 minutes in December 2007. The dedicated lab tech reduced RN resistance to the testing. Physicians comfort increased with exposure to testing.
Currently the ED POC lab is staffed by a lab tech 24 hours per day. BNP and ABG cartridges have been added based on the previous testing success. All respiratory therapist, ED charge nurses and relief charge nurses maintain competency on the I-STAT platforms. The lab tech has also been trained to run all urine POC.

Recommendations: The integration of the i-STAT POC testing in the ED process has been beneficial to care of a large percentage of the ED population. Collaboration with the laboratory enhanced our processes.

Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImproving ED Throughput with iSTAT Point of Care Testingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162516-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving ED Throughput with iSTAT Point of Care Testing</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Burnie, Jeannie, RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Bethesda North Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Department Staff Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">10501 Montgomery Road, Cincinnati, OH, 45243, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">513-745-1496</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Jeannie_burnie@trihealth.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Bonnie Sheedy, RN, BS; Pam Kotynski, M.H.A., BS, MT (ASCP)</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical Topic: I-STAT testing was underutilized in a Midwestern Suburban Emergency Department (ED) whose visits approach 60,000 patients per year. A multidisciplinary process improvement team was charged with determining why the testing was underutilized and to determine a method to improve usage. <br/>The team decided that the following issues caused under usage:<br/>1) Physicians did not order the test<br/>2) Physicians did not trust validity of test results<br/>3) Maintaining RN competency was a challenge<br/>4) RN's did not encourage use of i-STAT due to concerns with cost<br/>5) RN's believed that performing tests took too much time away from patient care<br/>6) Available cartridges lead to repeat laboratory testing causing concerns with duplicate charging<br/><br/>Implementation: A project team coordinator was instrumental in assisting the team to work towards process improvement. The team decided to streamline the types of cartridges available and to focus on tests that would impact a large volume of the current ED population. To enhance i-STAT use, an order set was developed in the electronic documentation system labeled Cardiac Workup i-STAT and included a Chemistry 8 and Troponin. Laboratory management agreed to a trial of assigning a dedicated laboratory technician in the ED from 11a-11p to run the tests. The ED staff received education regarding the change in available cartridges, the order set in the electronic documentation system and the process to follow during the trial times. The physicians were educated about the process change, the stringent validation process that the laboratory used to ensure test results and the potential benefit of patient throughput. The initial goals included:<br/><br/>1) Increase usage of the i-STAT platform<br/>2) Improve physician acceptance <br/>3) Decrease workload of nursing staff<br/>4) Rapid recognition of at risk cardiac patients<br/><br/>The trial was implemented over a one month period in the fall of 2007. The following parameters were measured:<br/><br/>1) ED patient length of stay<br/>2) Lab turnaround time (TAT) for I-STAT chem 8 and troponin compared to central lab TAT<br/>3) i-STAT lab TAT and time to disposition<br/><br/>Outcomes: The trial was an overwhelming success. Inclusion of the i-STAT order set in the electronic order sets eased order entry and cartridge use increased from 42 in July, 2007 to 2007 in December 2007. The ED disposition time improved from 2 hours 10 minutes in July 2007 to 1 hour and 11 minutes in December 2007. The dedicated lab tech reduced RN resistance to the testing. Physicians comfort increased with exposure to testing.<br/>Currently the ED POC lab is staffed by a lab tech 24 hours per day. BNP and ABG cartridges have been added based on the previous testing success. All respiratory therapist, ED charge nurses and relief charge nurses maintain competency on the I-STAT platforms. The lab tech has also been trained to run all urine POC.<br/><br/>Recommendations: The integration of the i-STAT POC testing in the ED process has been beneficial to care of a large percentage of the ED population. Collaboration with the laboratory enhanced our processes. <br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:29:31Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:31Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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