In this on-demand SelectScience webinar, point-of-care testing (POCT) manager Olubunmi Martindale-Sheldon presents the findings from her comparative study of urine chemistry analysis methods, used at Imperial College Healthcare, one of the largest healthcare trusts in the UK. She discusses the study set-up, which encompassed three hospitals and nine clinical areas with medium to high urinalysis volumes, as well as reviewing the results and outlining the benefits of using automation versus manual methods.
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Q: Can you further explain the difference between semi-automated and fully automated methods of urinalysis in your organization?
OMS: Both methods require the use of automated readers and getting printed results from the analyzer. However, the semi-automated method requires users to manually transcribe the test results onto an electronic patient record. That creates the potential for transcription errors, especially as you can have about eight to 10 test results to transcribe at any one time, depending on the reading strip type. This is also time consuming and that time can be better used elsewhere caring for our patients. On the other hand, the fully automated system does not require any manual transcription as the analyzers are linked to the patient's permanent record and so results are automatically added.
Q: Do you have any anecdotal evidence from users? Do they have a preference of the urinalysis methods used?
OMS: Firstly, it is worth mentioning that, since this study, we have seen an increase in the number of requests for the automated readers at the Imperial NHS Trust. Where we've implemented these automated readers in new areas, we do find that clinical staff feel this method takes more time, because they now need to scan the patients and the user ID, which they were not doing previously. So, we must explain that the automated system is actually better for ensuring results are accurate, from testing through to reporting. We have also used data from this study as evidence for how much time they are saving in the long run. This gets users to look at the bigger picture, not just the initial testing. There have also been a few observed situations where the manual method was not completed properly, or there were variables that impacted the interpretation of the results. For example, some users did not wait for the required time to complete the test before interpreting or recording the results, whereas others have complained about the lighting in their test areas. Additionally, color blindness could have a negative impact.
Q: Does Imperial College Healthcare use the same urine analyzers across all of the clinical areas which participated in the study?
OMS: Yes, all clinical areas that participated in this study use the same urine analyzer: the CLINITEK Status®+ Analyzer.
Q: Were you surprised by the 14% error rate for manual methods that you uncovered in your study?
OMS: Not really, I was more concerned, based on what we were seeing on the wards, that the protocols were not always being done properly. This was why I jumped at the opportunity to participate in the patient safety challenge. The main problem we have in POCT is that there is no central point of call. So, even if you find things that require improvement, it is difficult to raise these issues and implement whatever changes are needed to improve quality and safety. When I saw the patient safety challenge adverts on the trust intranet, as CSC manager I thought: 'It's going to take a lot of work and effort, but this is a good opportunity to obtain evidence to show to the trust, at the right level, that there are issues and something needs to be done about it.' So, now we have data evidence of the scale of these issues, including what can be done to mitigate these.
Q: How are you going to take this forward across the whole trust?
OMS: Since this study, we have taken this forward. We produced the report, which was approved by our PAC clinical lead, who was the senior officer responsible for this project. Then we took it to the POCT management group for the trust, the PAC committee. This group is responsible for the acquisition and introduction of POCT and safe use of POCT across the trust. We also took it to different meetings, including some high-level meetings, where everybody agreed that the data clearly showed things need to change. Having said that, because we have this evidence, the managers in the clinical areas themselves are now asking to put in requests to the PAC the committee for new automated readers. Additionally, since the study, we now have a significant number of CLINITEK analyzers – close to 20 compared to about three we had beforehand. So, it is increasing, and I'm aware of an application that has recently been submitted, that will go to our next PSD committee meeting as well for approval.
Q: A fully automated system seems to save costs significantly. But in the study, was consideration given to the cost of purchasing and maintaining the automated analyzers?
OMS: As mentioned, there will be cost implications in implementing the fully automated system, for example, the actual purchase of the analyzers and the IT maintenance costs. This is something that will need to be reviewed and the trust will need to be happy that you're happy to pay for this in the long run.
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