Expert Insight: Point of care blood gas testing: Impacts at a large community hospital

Patti DeJuilio discusses the implementation of POCT and highlights the impact on cost, sepsis bundle compliance, and employee engagement

22 Oct 2021

Patti DeJuilio, Clinical Director of Respiratory Care and Center for Sleep Health
Patti DeJuilio, Clinical Director of Respiratory Care and Center for Sleep Health

The implementation of point of care blood gas testing has the potential to drive significant improvements associated with clinical, operational, and financial outcomes. Specifically, the increased utilization of lactate testing with improved sepsis bundle compliance could lead to reduced mortality.

In this SelectScience webinar, now available on demand, Patti DeJuilio, Clinical Director of Respiratory Care and Center for Sleep Health discusses her experience of implementing point of care blood gas testing within Northwestern Medicine Central DuPage Hospital, Winfield, Illinois. DeJuilio provides valuable first-hand insights into:

  • The impact of POCT in achieving clinical, operational, and financial efficiencies
  • How POCT may improve patient outcomes

Think you’d benefit, but missed the live event? Register now to watch the webinar at a time that suits you or read on for highlights from the Q&A session.

What do you think of the testing procedure for point of care versus testing in the lab?

PD: The procedure itself is very simple, you put a card into the machine with the sample and the quality control is completed,  all in less than five minutes. The procedure also allows us to draw a lot less blood, which I think is remarkable. Still, to this day, I get physicians in adult care that are shocked at the small amount of blood that we can run samples on.

What equipment you are using for this point of care testing?

PD: We use the Siemens epoc® Blood Analysis System and we also have an AVOXimeter. We do use nitric oxide in the hospital, especially in our NICU, and now in our COVID-19 unit. We ran hemoglobins and we use an AVOX for that. However, the Siemens epoc is our go-to device.

Do you think this approach is suitable for all hospitals?

PD: I honestly can't imagine where it wouldn't be suitable. In our hospital, we have a level III NICU, a PICU, cardiac ICU, and neuro-ICU - we're a primary stroke center. We have quite a diverse patient population and there's nowhere where I have felt that POCT wasn't useful. We jumped into this approach head-on and didn't keep the benchtop anywhere, and it's been a remarkable journey. I can't imagine a hospital that couldn't use it.

What improvements do you see for point of care testing?

PD: First of all, when we reviewed point of care testing, I think that true point of care should be a handheld device. I think devices that need to be on carts in travel pose the same problems and considerations that benchtop analyzers have. I believe that our true point of care test is a device that can be carried into the room. I think that improvements here would just be additional tests. It would be really wonderful to have one card with 0.5 to 1 cc able to run multiple different analytes. That would be pretty spectacular.

As we look into the future from a caregiver perspective, what are some of the ways we could improve patient-side testing in critical care and/or respiratory therapy settings?

PD: First of all, as departments in hospital settings, we all need to look outside the box and recognize that, due to healthcare changes and bundled payments for patients, we are not individual businesses as we were at one time. We all should be looking to contribute to the endgame; the patient outcome, and the cost outcome. One struggle that I've heard over and over again is that the lab doesn't necessarily want to give up its revenue to a different team to do bedside testing. I struggle with that. I totally understand that we're all accountable for revenue. However, I ask that people think outside the box about how can we contribute even though it's giving up revenue. I heard about the revenue that the lab would be giving up when we took over lactate. However, they were happy to do so. Additionally, I would love to see more results generated with less blood, less sample cards. I think that it would be absolutely ideal to have more measures that we could put into one card that we run.

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