Laboratory process improvement through point-of-care testing.

Background: In the 1992-1996 period Methodist Clinical Laboratory Services of the Methodist Health Group, Indianapolis, was restructuring all work processes. In one initiative, point-of-care testing (POCT) was used to optimize the decision cycle time while reducing the overall cost of providing information. DEVELOPING THE COMPARATIVE MODEL: In a typical month (May 1994) for hospital admissions and laboratory usage, events related to the traditional blood analysis process were observed. In March 1995 the same model that was applied to analyze the traditional blood analysis process was used to evaluate the newly implemented POCT blood analysis process. Comparisons of both processes, cost per test panel, nursing time spent, and overall turnaround time were made between the two methodologies.

Results: A restructure of delivery of blood analysis with the POCT system saved the hospital $392, 336 compared to the total annual cost of the traditional approach for delivering blood analysis. The average cost per test panel was $15.33 with the traditional model and $8.03 with the POCT system. Improvements in the overall turnaround time of test results affected the decision cycle time of the caregiver. The POCT system saved four steps on the patient care floor and ten in the laboratory.

Discussion: It is critical to establish a POCT committee, including the most vocal critics of POCT1-to look at how a program of this nature will affect the organization.

Conclusions: POCT became more than just an isolated change-it became a core strategy of moving laboratory testing out of the traditional laboratory setting to where it could become immediately accessible to caregivers as information.