Added value of a connected glucose meter for glycorrhachia assessment

Objectives

The aim of this study was to demonstrate the performance and added value of rapid glucose determination in cerebrospinal fluid using a connected glucometer.

Design and Methods

Intra-assay and inter-assay accuracies were calculated using residual clinical samples. Accuracies were measured by comparing the results obtained with the glucometer to those from the central laboratory on a large routine chemistry platform.

Results

The intra-assay coefficients of variation were between 6.1% and 6.2% for low values (18 mg/dL) and between 5.6% and 6.8% for high values (58 mg/dL). The inter-assay coefficients of variation were between 9.4% and 16.3% for the low values (18 mg/dL) and between 5.7% and 8.7% for the high values (pool; ±75 mg/dL). The regression equation by comparison to the central laboratory was y = 4.08 + 0.82 x, with a coefficient of determination (r2) of 0.95.

Conclusions

The measurement of glycorrhachia with a connected glucometer before the analysis in the central laboratory allows a rapid orientation in the deferential diagnosis of a meningitis of viral vs bacterial origin. The response time is fast (6 s) and requires only a small amount of fluid (1.2 μL), which is important in infants, especially since lumbar puncture is an integral part of the investigation of the origin of a fever in this population.

Selecting patient accounting systems: what are the key criteria?

A recent survey of healthcare finance executives on patient accounting system usage provided information on how key decisions about systems are made. Results show that decision makers are handicapped in the decision-making process because they are aware of only a subset of available systems, decreasing the likelihood of selecting the best possible system.

Patient accounting systems: needs and capabilities

In the first article of this series, it was stated that most finance executives are not very satisfied with the performance of their current patient accounting systems. What steps can a patient accounting system planner take to help ensure the system selected will garner high ratings from managers and users? Two primarily steps need to be taken. First, the planner needs to perform a thorough evaluation of both near- and long-term patient accounting requirements. He should determine which features and functions are most critical and ensure they are incorporated as selection criteria. The planner should also incorporate institutional planning into that process, such as planned expansion of facilities or services, to ensure that the system selected has the growth potential, interfacing capabilities, and flexibility to respond to the changing environment. Then, once system needs are fully charted, the planner should educate himself about the range of patient accounting system solutions available. The data show that most financial managers lack knowledge about most of the major patient accounting system vendors in the marketplace. Once vendors that offer systems that seemingly could meet needs are identified, the wise system planner will also want to obtain information from users about those vendors, to determine whether the systems perform as described and whether the vendor has been responsive to the needs of its customers. This step is a particularly important part of the planning process, because the data also show that users of some systems are significantly more satisfied than users of other patient accounting systems.

Selecting patient accounting systems that stand out from the rest

How satisfied is the average finance executive with the performance of his institution's patient accounting system? Not very. What causes this dissatisfaction? A variety of factors: Not enough flexibility, the inability to modify or expand the system, the lack of system interfaces, and inadequate support. These are all leading contributors to the finance executive's dissatisfaction. How much information does he have about the alternative patient accounting system vendors in the marketplace? On average, limited information. Many vendors who offer patient accounting systems have not done enough to disseminate information about their products to hospital decision makers. If the finance executive were more knowledgeable about the alternatives available, would he then be able to select a patient accounting system that fully meets the institution's needs? It would improve the odds. However, merely knowing about the alternatives is only the first step. He must be able to fully evaluate the institution's near and long-term needs to create the best match possible. The finance executive must also accept the possibility that there may not be a single system in the marketplace that can accommodate every perceived need. Only by knowledge of the marketplace will he be in a position to fully evaluate the potential benefits of the available systems.