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Al-Hasani W, Ranasinghe R, Rogers H, Spanier W, Spears K, Gayle C, Long L, Dimitriadis GK, Hunt KF, Vincent RP. Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes: Prospective cohort study. BJOG 2024; 131:1270-1278. [PMID: 38497098 DOI: 10.1111/1471-0528.17811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To assess the clinical utility of point-of-care (POC) capillary blood glucose (CBG) testing in the assessment of gestational diabetes mellitus (GDM) during oral glucose tolerance test (OGTT). DESIGN Prospective cohort study. SETTING Antenatal clinics at King's College Hospital. POPULATION Women screened for GDM between March and June 2020. METHODS The CBG was measured using the POC StatStrip® test and the venous plasma glucose (VPG) was measured by Roche analyser (Cobas 8000 c702). GDM was diagnosed based on the 2015 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline criteria. The two methods were compared statistically using Analyse-It 5.40.2. MAIN OUTCOME MEASURES Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the POC StatStrip® test, compared with VPG measured by reference laboratory method. RESULTS A total of 230 women were included. The number and percentage of women with glucose concentrations above the GDM threshold using the POC StatStrip® test versus laboratory VPG measurement was 15 (6.5%) versus eight (3.4%) at fasting and 105 (45.6%) versus 72 (31.1%) at 2 h, respectively. The sensitivity and specificity values (and 95% CIs) for the POC StatStrip® test were 88% (52%-99%) and 97% (93%-98%) at fasting and 97% (91%-99%) and 79% (71%-84%) at 2 h, respectively. However, the specificity and the NPV for the POC StatStrip® test for concentrations of ≤5.0 mmol/L at fasting or <7.5 mmol/L at 2 h were 100%, and the sensitivity and the PPV for concentrations of >9.5 mmol/L at 2 h were 100%. CONCLUSIONS In our cohort the POC measurement of CBG cannot entirely replace the laboratory method for the OGTT; however, it can be used to rule out/rule in GDM for glucose concentrations of ≤5.0 mmol/L at fasting or <7.5/>9.5 mmol/L at 2 h.
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Affiliation(s)
- Wiaam Al-Hasani
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Ruvini Ranasinghe
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - William Spanier
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Katie Spears
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Carol Gayle
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Long
- Department of Obstetrics, King's College Hospital NHS Foundation Trust, London, UK
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Katharine F Hunt
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Hermans LE, Centner CM, Morel CM, Mbamalu O, Bonaconsa C, Ferreyra C, Lindahl O, Mendelson M. Point-of-care diagnostics for infection and antimicrobial resistance in sub-Saharan Africa: A narrative review. Int J Infect Dis 2024; 142:106907. [PMID: 38141961 DOI: 10.1016/j.ijid.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVES Sub-Saharan African (SSA) countries are severely impacted by antimicrobial resistance (AMR). Due to gaps in access to diagnostics in SSA, the true extent of AMR remains unknown. This diagnostic gap affects patient management and leads to significant antimicrobial overuse. This review explores how point-of-care (POC) testing for pathogen identification and AMR may be used to close the diagnostic gap in SSA countries. METHODS A narrative review exploring current clinical practice and novel developments in the field of POC testing for infectious diseases and AMR. RESULTS POC assays for identification of various pathogens have been successfully rolled out in SSA countries. While implementation studies have mostly highlighted impressive test performance of POC assays, there is limited data on the impact of implementation on clinical outcomes and cost-effectiveness. We did not encounter local studies of host-directed POC assays relevant to AMR. Novel POC assays using real-time polymerase chain reaction, isothermal amplification, microfluidics, and other technologies are in various stages of development. CONCLUSIONS Available literature shows that POC testing for AMR applications is implementable in SSA and holds the potential to reduce the diagnostic gap. Implementation will require effective regulatory pathways, incorporation of POC testing in clinical and laboratory guidelines, and adequate value capture in existing health financing models.
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Affiliation(s)
- Lucas Etienne Hermans
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Chad M Centner
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Chantal M Morel
- Department of Business Studies, Uppsala University, Uppsala, Sweden; Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany; University of Bern, KPM Center for Public Management, Bern, Switzerland
| | - Oluchi Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Candice Bonaconsa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Cecilia Ferreyra
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Olof Lindahl
- Department of Business Studies, Uppsala University, Uppsala, Sweden
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Vealan K, Joseph N, Alimat S, Karumbati AS, Thilakavathy K. Lateral flow assay: a promising rapid point-of-care testing tool for infections and non-communicable diseases. ASIAN BIOMED 2023; 17:250-266. [PMID: 38161347 PMCID: PMC10754503 DOI: 10.2478/abm-2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The point-of-care testing (POCT) approach has established itself as having remarkable importance in diagnosing various infectious and non-communicable diseases (NCDs). The POCT approach has succeeded in meeting the current demand for having diagnostic strategies that can provide fast, sensitive, and highly accurate test results without involving complicated procedures. This has been accomplished by introducing rapid bioanalytical tools or biosensors such as lateral flow assays (LFAs). The production cost of these tools is very low, allowing developing countries with limited resources to utilize them or produce them on their own. Thus, their use has grown in various fields in recent years. More importantly, LFAs have created the possibility for a new era of incorporating nanotechnology in disease diagnosis and have already attained significant commercial success worldwide, making POCT an essential approach not just for now but also for the future. In this review, we have provided an overview of POCT and its evolution into the most promising rapid diagnostic approach. We also elaborate on LFAs with a special focus on nucleic acid LFAs.
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Affiliation(s)
- Kumaravel Vealan
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang43400, Malaysia
| | - Narcisse Joseph
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang43400, Malaysia
| | - Sharizah Alimat
- Department of Chemistry Malaysia, Ministry of Science, Technology and Innovation, Petaling Jaya46661, Selangor, Malaysia
| | - Anandi S. Karumbati
- Centre for Chemical Biology and Therapeutics, Institute for Stem Cell Science and Regenerative Medicine, Bangalore560065, India
| | - Karuppiah Thilakavathy
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang43400, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, UPM Serdang43400, Selangor, Malaysia
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Martín-Rodríguez F, Vaquerizo-Villar F, López-Izquierdo R, Castro-Villamor MA, Sanz-García A, Del Pozo-Vegas C, Hornero R. Derivation and validation of a blood biomarker score for 2-day mortality prediction from prehospital care: a multicenter, cohort, EMS-based study. Intern Emerg Med 2023; 18:1797-1806. [PMID: 37079244 PMCID: PMC10116443 DOI: 10.1007/s11739-023-03268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
Identifying potentially life-threatening diseases is a key challenge for emergency medical services. This study aims at examining the role of different prehospital biomarkers from point-of-care testing to derive and validate a score to detect 2-day in-hospital mortality. We conducted a prospective, observational, prehospital, ongoing, and derivation-validation study in three Spanish provinces, in adults evacuated by ambulance and admitted to the emergency department. A total of 23 ambulance-based biomarkers were collected from each patient. A biomarker score based on logistic regression was fitted to predict 2-day mortality from an optimum subset of variables from prehospital blood analysis, obtained through an automated feature selection stage. 2806 cases were analyzed, with a median age of 68 (interquartile range 51-81), 42.3% of women, and a 2-day mortality rate of 5.5% (154 non-survivors). The blood biomarker score was constituted by the partial pressure of carbon dioxide, lactate, and creatinine. The score fitted with logistic regression using these biomarkers reached a high performance to predict 2-day mortality, with an AUC of 0.933 (95% CI 0.841-0.973). The following risk levels for 2-day mortality were identified from the score: low risk (score < 1), where only 8.2% of non-survivors were assigned to; medium risk (1 ≤ score < 4); and high risk (score ≥ 4), where the 2-day mortality rate was 57.6%. The novel blood biomarker score provides an excellent association with 2-day in-hospital mortality, as well as real-time feedback on the metabolic-respiratory patient status. Thus, this score can help in the decision-making process at critical moments in life-threatening situations.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Facultad de Medicina, Universidad de Valladolid, Av. Ramón y Cajal, 7, 47003, Valladolid, Spain.
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain.
| | - Raúl López-Izquierdo
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Miguel A Castro-Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Ancor Sanz-García
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain
| | - Carlos Del Pozo-Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, Facultad de Medicina, Universidad de Valladolid, Av. Ramón y Cajal, 7, 47003, Valladolid, Spain
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
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Moetlhoa B, Maluleke K, Mathebula EM, Kgarosi K, Nxele SR, Lenonyane B, Mashamba-Thompson T. REASSURED diagnostics at point-of-care in sub-Saharan Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001443. [PMID: 37276194 DOI: 10.1371/journal.pgph.0001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
Point-of-care (POC) diagnostics that meet the REASSURED criteria are essential in combating the rapid increase and severity of global health emergencies caused by infectious diseases. However, little is known about whether the REASSURED criteria are implemented in regions known to have a high burden of infectious diseases such as sub-Saharan Africa (SSA). This scoping review maps evidence of the use of REASSURED POC diagnostic tests in SSA. The scoping review was guided by the advanced methodological framework of Arksey and O'Malley, and Levac et al. We searched the following electronic databases for relevant literature: Scopus, Dimensions, ProQuest Central, Google Scholar, and EBSCOhost (MEDLINE, CINAHL, as well as AFRICA-WIDE). Two reviewers independently screened abstracts and full-text articles using the inclusion criteria as reference. We appraised the quality of the included studies using the mixed-method appraisal tool (MMAT) version 2018. We retrieved 138 publications, comprising 134 articles and four grey literature articles. Of these, only five articles were included following abstract and full-text screening. The five included studies were all conducted in SSA. The following themes emerged from the eligible articles: quality assurance on accuracy of REASSURED POC diagnostic tests, sustainability of REASSURED POC diagnostic tests, and local infrastructure capability for delivering REASSURED POC diagnostic tests to end users. All five articles had MMAT scores between 90% and 100%. In conclusion, our scoping review revealed limited published research on REASSURED diagnostics at POC in SSA. We recommend primary studies aimed at investigating the implementation of REASSURED POC diagnostic tests in SSA.
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Affiliation(s)
- Boitumelo Moetlhoa
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Kuhlula Maluleke
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Evans M Mathebula
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Medical and Scientific Affairs, Rapid Diagnostics, Infectious Diseases Emerging Markets, Abbot Rapid Diagnostics (Pty) Ltd, Sandton, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, Department of Library Services, University of Pretoria, Pretoria, South Africa
| | - Siphesihle R Nxele
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Bonolo Lenonyane
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Atallah J, Archambault D, Randall JD, Shepro A, Styskal LE, Glenn DR, Connolly CB, Katsis K, Gallagher K, Ghebremichael M, Mansour MK. Rapid Quantum Magnetic IL-6 Point-of-Care Assay in Patients Hospitalized with COVID-19. Diagnostics (Basel) 2022; 12:1164. [PMID: 35626318 PMCID: PMC9139897 DOI: 10.3390/diagnostics12051164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022] Open
Abstract
Interleukin-6 (IL-6) has been linked to several life-threatening disease processes. Developing a point-of-care testing platform for the immediate and accurate detection of IL-6 concentrations could present a valuable tool for improving clinical management in patients with IL-6-mediated diseases. Drawing on an available biobank of samples from 35 patients hospitalized with COVID-19, a novel quantum-magnetic sensing platform is used to determine plasma IL-6 concentrations. A strong correlation was observed between IL-6 levels measured by QDTI10x and the Luminex assay (r = 0.70, p-value < 0.001) and between QDTI80x and Luminex (r = 0.82, p-value < 0.001). To validate the non-inferiority of QDTI to Luminex in terms of the accuracy of IL-6 measurement, two clinical parameters—the need for intensive care unit admission and the need for mechanical intubation—were chosen. IL-6 concentrations measured by the two assays were compared with respect to these clinical outcomes. Results demonstrated a comparative predictive performance between the two assays with a significant correlation coefficient. Conclusion: In short, the QDTI assay holds promise for implementation as a potential tool for rapid clinical decision in patients with IL-6-mediated diseases. It could also reduce healthcare costs and enable the development of future various biomolecule point-of-care tests for different clinical scenarios.
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Affiliation(s)
- Johnny Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.); (D.A.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (K.K.); (K.G.); (M.G.)
| | - Dakota Archambault
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.); (D.A.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (K.K.); (K.G.); (M.G.)
| | - Jeffrey D. Randall
- Quantum Diamond Technologies Inc., Somerville, MA 02143, USA; (J.D.R.); (A.S.); (L.E.S.); (D.R.G.); (C.B.C.)
| | - Adam Shepro
- Quantum Diamond Technologies Inc., Somerville, MA 02143, USA; (J.D.R.); (A.S.); (L.E.S.); (D.R.G.); (C.B.C.)
| | - Lauren E. Styskal
- Quantum Diamond Technologies Inc., Somerville, MA 02143, USA; (J.D.R.); (A.S.); (L.E.S.); (D.R.G.); (C.B.C.)
| | - David R. Glenn
- Quantum Diamond Technologies Inc., Somerville, MA 02143, USA; (J.D.R.); (A.S.); (L.E.S.); (D.R.G.); (C.B.C.)
| | - Colin B. Connolly
- Quantum Diamond Technologies Inc., Somerville, MA 02143, USA; (J.D.R.); (A.S.); (L.E.S.); (D.R.G.); (C.B.C.)
| | - Katelin Katsis
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (K.K.); (K.G.); (M.G.)
| | - Kathleen Gallagher
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (K.K.); (K.G.); (M.G.)
| | - Musie Ghebremichael
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (K.K.); (K.G.); (M.G.)
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02138, USA
| | - Michael K. Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.); (D.A.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (K.K.); (K.G.); (M.G.)
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Jimenez-Barragan M, Rodriguez-Oliva M, Sanchez-Mora C, Navarro-Bustos C, Fuentes-Cantero S, Martin-Perez S, Garrido-Castilla JM, Undabeytia-Lopez L, Luque-Cid A, de Miguel-Melendez J, Leon-Justel A. Emergency severity level-3 patient flow based on point-of-care testing improves patient outcomes. Clin Chim Acta 2021; 523:144-151. [PMID: 34537218 DOI: 10.1016/j.cca.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Overcrowding of the Emergency Department is rapidly becoming a global challenge and a major source of concern for emergency physicians. The desire to improve Emergency Department throughput requires novel approaches to patient flow. MATERIALS AND METHODS We conducted a prospective and cluster-randomized study, to evaluate the impact in patient outcomes of a new patient flow based on Point-of-Care Testing (POCT). A total of 380 Emergency Severity Level-3 patients were enrolled and studied in two different groups, interventional arm (laboratory analyses performed on POCT analyzers implemented in the Emergency Department) or control arm (central laboratory). The primary outcome was the Emergency Department length of stay. Secondary outcome included the time to first medical intervention, the laboratory turnaround time and the time to disposition decision. Readmission within the 7 days after discharge was also calculated. RESULTS Length of stay significantly decreased by 88.50 min (from 247.00 to 158.50), time to disposition decision by 89.00 min (from 192.00 to 103.00) and laboratory turnaround time by 67.11 min (from 89.84 to 22.73) in the POCT group. No increase in readmission was found. CONCLUSION Our strategy based on POCT represents a good approach to optimize patient flow in the Emergency Department and it should be seen as a starting point for further studies focusing on improving throughput.
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Affiliation(s)
- Marta Jimenez-Barragan
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Manuel Rodriguez-Oliva
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Catalina Sanchez-Mora
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Carmen Navarro-Bustos
- Emergency Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Sandra Fuentes-Cantero
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Salomon Martin-Perez
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | | | - Luisa Undabeytia-Lopez
- Emergency Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Antonio Luque-Cid
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Juan de Miguel-Melendez
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Antonio Leon-Justel
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain.
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Chase RA, DeJuilio PA, Huml JP, Johnson AP, Kaminski RM. Implementation of point-of-care blood gas testing at a large community hospital: Cost analysis, sepsis bundle compliance, and employee engagement. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2021; 57:60-67. [PMID: 34164573 PMCID: PMC8177004 DOI: 10.29390/cjrt-2021-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION/BACKGROUND Point-of-care testing (POCT) platforms support patient-centered approaches to health care delivery and may improve patient care. We evaluated implementation of a POCT platform at a large, acute care hospital in the Midwestern United States. METHODS We used lactate testing as part of a sepsis bundle protocol to evaluate compliance and mortality outcomes. Respiratory team members were surveyed to assess perception of efficiency, ease of use, timely patient care, and overall engagement with the POCT system. Annualized cost per test of a benchtop analyzer and a POCT platform were compared across 3 years for each platform. RESULTS Lactate testing volume increased from 61% to 91%, which was associated with improved sepsis bundle protocol compliance. Employees reported high levels of engagement, improvements in efficiency and time savings, and better patient care with POCT. Average cost per test was $10.02 for the benchtop system and $6.21 for the POCT platform. POCT saved our institution $88,476 annually in labor costs. DISCUSSION Combined with a robust training program emphasizing the use of lactate testing in the context of the overall clinical picture, POCT enabled adherence to the sepsis bundle protocol and may have contributed to lower mortality. Additionally, the COVID-19 pandemic has provided us with unanticipated benefits of using POCT; it has enhanced our ability to deal with stringent infectious disease protocols, saving time and minimizing patient and staff exposure. CONCLUSIONS Implementation of a POCT platform was associated with improved compliance to our sepsis protocol, reduced sepsis mortality, high employee engagement, and cost savings.
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Affiliation(s)
- Robert A Chase
- Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | | | - Jeffrey P Huml
- Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Alex P Johnson
- Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Ryan M Kaminski
- Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
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