Abstract
Background Advance BioScience Laboratories (ABL) 90 Radiometers are more costly than other machines because of their consumables.1 They provide timely results for blood gases helping physicians with decision making. Pre-analytical errors are mostly the reason for failed blood tests and contribute to 0.23% to 1.2% of total hospital operating expenses. This avoidable expenditure can be deduced to cost a U.S. hospital with around 650 beds around $1.2 million per year.2 This also can lead to patients’ dissatisfaction due to re-pricking and prolonged hospital stay which generates greater cost.3 This project aimed to reduce the cost of failed blood gas tests in Hamad General Hospital (Doha, Qatar), Acute Medical Assessment Unit 1 by 30% from the baseline of 378 QAR from 31 August 2023 to 265 QAR by 31 December 2023.
Methods A cost analysis of Arterial Blood Gas machines was conducted. All quantifiable items and consumables were computed based on the type of syringe used (PICO or Microsampler) and type of tests (arterial or venous). Failed blood gas tests are defined as aborted samples and incomplete samples that require re-processing. Proficiency testing was the only exclusion.
Results After thirteen weeks of interventions, the cost of failed blood gas tests was consistently below the 265 QAR target per week (figure 1). The utilization of PICO syringes (figure 2) has been effective in reducing the pre-analytical errors such as clot, haemolysis, and air bubbles. However, despite the utilization of such syringe, there are still notable fluctuations in the expenditure due to poor technique.
Conclusion Failed blood gas tests have significant consequences including wastage of supplies, nurse’s service time, and patient’s dissatisfaction. Usage of PICO syringe showed positive effect in minimizing failed tests combined with properly performing the steps in running the sample that significantly reduce the cost of failed blood gas test.
Expenses generated per week by failed point-of-care testing blood gas tests in the acute medical assessment unit 1 of hamad general hospital, Doha, Qatar
Percentage of PICO syringe usage in the acute medical assessment unit 1 of Hamad general hospital, Doha, Qatar
References
Müller MM, Hackl W, Griesmacher A. Point-of-care-testing--das intensivlaboratorium [point-of-care-testing--the intensive care laboratory]. Anaesthesist 1999 Jan;48(1):3–8. German. https://doi.org/10.1007/s001010050661
Kaushik N. Pre-analytical errors: their impact and how to minimize them [Internet]. Medical Laboratory Observer 2015. Available from: https://www.mlo-online.com/home/article/13006606/preanalytical-errors-their-impact-and-how-to-minimize-them Accessed 16 July 2024
Karcher DS, Lehman CM. Clinical consequences of specimen rejection: a college of American pathologists q-probes analysis of 78 clinical laboratories. Archives of Pathology & Laboratory Medicine 2014 Aug;138(8):1003–8. https://doi.org/10.5858/arpa.2013-0331-CP
Ethical Approval/IRB Statement This Quality Improvement study was approved by the leadership of the Acute Medical Assessment Department at Hamad General Hospital, Doha, Qatar.
Disclosures and Acknowledgments The authors wish to acknowledge all the speakers in National Value Improvement Collaborative sessions for sharing their knowledge and be a beacon of improvement. Also, we extend our gratitude to all the leaders as well as staff members for continuously supporting the project. Lastly, the author would like to thank our coach for the guidance and empowerment.
