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The Economic and Clinical Efficiency of Point-of-Care Testing for Critically Ill Patients: A Decision-Analysis Model

MEDTAP International, Inc., Bethesda, Maryland

Cynthia S. Palmer, M.Sc.

MEDTAP International, Inc., Bethesda, Maryland

Kit N. Simpson, Dr.P.H.

University of North Carolina School of Public Health, Chapel Hill, North Carolina

Francis D. Chesley, M.D.

Agency for Health Care Policy and Research, Rockville, Maryland

Bryan R. Luce, Ph.D., M.B.A.

MEDTAP International, Inc., Bethesda, Maryland

Johan P. Suyderhoud, M.D.

Georgetown University Medical School, Washington, D.C.

Bonnie V. Neibauer, R.N., M.S.N., C.C.R.N.

Washington Adventist Hospital, Takoma Park, Maryland

Fawzy G. Estafanous, M.D.

The Cleveland Clinic Foundation, Cleveland, Ohio

Our study objective was to assess economic and clin ical outcomes of use of a point-of-care (POC) blood analy sis device for postoperative coronary artery bypass graft (CABG) patients. A decision analytic model was devel oped for patients with high expected use of blood analy sis, high potential benefit from rapid turn around time of results, a large annual volume of patients, and sub stantial expense associated with surgery. Published lit erature and clinical experts provided incidence, outcome, and cost estimates associated with four clinical scenar ios potentially influenced by POC testing (ventricular arrhythmias, cardiac arrest, severe postoperative bleed ing, and iatrogenic anemia). We found that changes in clinical outcomes were predominantly dependent on com parative turn around time or CABG patient volume. The positive clinical impact of using POC testing was con sistently associated with a positive economic impact. POC blood gas analysis may be associated with decreased incidence of adverse clinical events or earlier detection of such events, resulting in significant cost savings. This study also supports previous findings that the costs of STAT blood analysis are more personnel-related than equipment-related.

American Journal of Medical Quality, Vol. 13, No. 1, 3-12 (1998)
DOI: 10.1177/106286069801300102


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