Point-of-Care Laboratory Management in the O.R. Setting: Our Opti CCA Experience

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Point-of-Care Laboratory Management in the O.R.
Setting Our Opti CCA Experience
Howard Coston, BS, CCP, LP Winston-Salem, NC
Central Carolina Perfusion Associates,
Inc. Winston-Salem, NC

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Overview A Historical Timeline

• Cardiac Program History
• Forsyth Medical Center 850 beds, 2nd largest
  hospital in NC
• Cardiac program initiated in 1987
• Current annual caseload 700 procedures, all
  adult
• 4 perfusionists staffing 3 operating rooms

• Point of Care History
• 1987 2001 Succession of large, table-top
  Ciba-Corning devices typical
• for a standard lab, very heavy with no
  portability
• - placed in the perfusion department work
  room, centrally located
• between 3 O.R. rooms
• - supervised maintained by the respiratory
  department
• - significant time required to maintain
  multiple electrodes required
• to perform range of tests necessary for
  cardiac surgery arena
• - complicated reagent and blood/waste
  product management
• - necessitated dedicated personnel to
  perform tests

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A New Day Dawns!
But soft, what light through yonder window
breaks? Romeo

• 2000 New Point-of-Care coordinator from the
  main lab arrives!

• Needs assessment review with Perfusion and POC
  coordinator
• a) Low maintenance
• b) Reliability of testing outcomes
• c) Portability
• d) Electronic controls
• e) Storage of testing supplies
• f) Data management
• g) Customer and technical support
• Ultimately chose to evaluate I-Stat, Gem Opti

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Needs Assessment Outcomes The Envelope Please!

• Low Maintenance/Supplies Storage/Portability
• ? No reagents, single use cassettes that
  calibrate prior to use
• ? Room temperature cassette storage never
  refrigerated
• ? Standing inventory orders, with flexibility
  for caseload variability
• ? No waste fluids or blood to be disposed of
• ? AC or battery operation
• ? Small size (12 lbs) does not require dedicated
  space
• ? Virtually no moving parts to fail
• - approximately once a year replace aspiration
  pump
• - occasionally requires fuse replacement
• Note both interventions managed by POC
  staff, does
• not require biomed
  department assistance
• ? Still have 4 original instruments with only
  minor repairs (7
• years as of 9/2008)

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Needs Assessment Outcomes The Envelope Please!

• Testing Reliability/CAP Compliance/QCs
• ? Electronic controls for daily QCs (3 levels
  every 8 hours)
• ? Liquid QCs performed monthly with each
  cassette shipment
• ? Validation studies correlate with main
  laboratory instruments
• ? Automatic aspiration of sample
• ? Co-oximeter technology for Hgb measurement,
  not calculation
• ? Rare cassette failure (typically dirty
  optics)
• ? CAP Proficiency Testing
• - commercially available QCs for Blood
  Gas/Electrolytes
• - Hgb technology unique no available
  commercial QCs
• CAP if no testing product available
  commercially , an
• acceptable alternative must be developed
• - POC department developed in-house alternative

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Needs Assessment Outcomes The Envelope Please!

• Data Management
• ? Integrated printer 1 copy each for
  anesthesia and perfusion
• - thermal paper cannot be placed in the
  Medical Record
• ? QC and patient testing information downloaded
  weekly to
• main lab (network docking station in
  perfusion work room)

4. Customer Technical Support ? FMC was
early user for the O.R. setting ? Early
challenges - CAP proficiency survey
deficiencies Minimum 10 peer group
participants for benchmarking
Non-comparable other instrument survey group
Extensive liaison work with CAP done by
tech support - Proprietary Hgb measurement
technology (QC dilemma) ? POC manager
characterized customer and technical support
as incredible
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The Point-of-Care Benefits

• Significantly decreased maintenance requirements
• Decreased perfusion personnel requirements
• Rapid turn-around time for lab results (lt 3
  minutes)
• Facilitation of tight glucose management
• Simple management of 5,163 patient tests in 2007
• - 4,647 cardiac surgery tests (7.4
  tests/procedure)
• - 516 main O.R. tests
• managed by anesthesia tech staff

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Thank You