Emergency ward tactics.
The Health Sciences Centre's Emergency Department gets it all.
More than 120 traumatized people in a 24-hour period come through the front door, heart attacks, accident victims, construction injuries. A myriad of other medical cases arrive at the door demanding immediate attention from doctors and nurses. Time is critical in diagnosis.
A major medical check which can tell a doctor a lot is a blood test. But at the moment the turn around time on a blood test is 30-120 minutes.
Getting results in two minutes from a bedside check would be a miracle. And that miracle is about to happen. A brand new piece of medical engineering wizardry will now analyse blood in two minutes. It will be part of a three-month analysis to gauge patient care in the emergency ward.
The computerized blood chemistry analyser has been provided from an American biodiagnostics company, Nova Biomedical. The project is sponsored by a grant from The Health Sciences Centre Foundation, whose money for the project comes from private donations.
Janet Walker, Executive Director of the Foundation, says $30,000 has been made available to the project which was conceived and initiated by Dr. Louis Ludwig, Medical Director of Adult Emergency Medicine at the Health Sciences Centre. The project started in June.
Says Walker, "This is an important project as it may determine whether prompt blood testing can increase the flow of patients through emergency and improve medical service."
Doctors and nurses will have laboratory quality blood test results at the bedside. A review of patients seen in the Health Sciences Centre's emergency department found that about 45% of all patients have some blood work done and 17% of all patients meet the criteria for the point-of-care testing device.
"I'm very excited about this," says Dr. Ludwig. "Approximately 250 patients a month can be included in the study. We're setting up a carefully controlled study so the results will be acceptable to the medical community."
He says this is being done because there has been some healthy skepticism by physicians about point-of-care testing and its usefulness.
"For example, blood testing on the machine gives us a reading of blood sugar, which is important for diabetics. Potassium, also measurable at bedside can be dangerously elevated in kidney failure," he says.
Dr. Ludwig adds that physicians tend to order too many tests for a variety of reasons, not necessarily based on solid scientific evidence."
He says there is no incentive nor disincentive to alter this practice. Point-of-care testing may give doctors selected results in two minutes.
"It will be interesting to see how patient management changes in terms of ordering lab tests beyond the scope of point-of-care technology. The incentive to order fewer tests on any given patient is the reward of having the results to act on in two minutes," he says.
Dr. Ludwig says it could be that patterns of practice will change and the 17 per cent (fitting the criteria) may increase or decrease or perhaps stay the same. The (usual) two hour delay for test results gives doctors time to observe the patient and let the facts percolate. If doctors receive the results in two minutes, a decision must be made sooner.
He is very optimistic about the possibilities of point-of-care testing. Two groups of patients will be involved, all of whom fit the criteria for the point-of-care blood work testing. One group will be tested with results coming back from a central lab. The second group will receive point-of-care testing.
"We'll be able to see if the average length of stay in the emergency department is reduced. Intuitively you would think so, but one study has shown that's not the case. The technology has been proven already, so we're just asking the one question about length of stay."
While the study's primary focus is length of stay and, therefore, quality of patient care, it will provide some cost comparisons between point-of-care testing and lab tests. Ludwig says the cost differences might prove to be neutral, but if point-of-care testing improves patient care, that's the ultimate objective. Some of the devices may be prohibitive for some departments and facilities, but as more manufacturers develop devices for point-of-care testing prices are expected to come down.
There had been some concern about the reliability of the bedside tests. Before the devices reached the emergency department, however, they were tested in the lab for some months to ensure their results correlated with the lab test results.
Among the other point-of-care testing devices being considered is one that measures heart attack markers such as enzymes. Measuring these markers helps medical staff determine if a person has suffered a heart attack. Obtaining results from current testing devices for these markers takes two or more hours from the central laboratory. One point-of-care device promises the result at the bedside in about 20 minutes, a remarkable saving in diagnostic time.
Whatever the outcome in the emergency department, point-of-care testing devices may prove valuable elsewhere such as nursing stations in northern Manitoba. Delays in such remote districts can be considerably longer than two hours when awaiting test results from a central lab. Therefore, the possible use of point-of-care testing procedures in patient monitoring may offer a very useful new tool to enhance patient care management not just in the urban sector but in isolated areas of the province.
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|Title Annotation:||The Practice of Good Medicine|
|Date:||Jun 1, 1997|
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