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Implementing Nurse Implementing Nurse Driven Point of Care Driven Point of Care Testing as a Chest Pain Testing as a Chest Pain Center Accredited within Center Accredited within the Emergency Department the Emergency Department Presenters: Presenters: Chris Vanni & Chris Vanni & Kathryn Lannon Kathryn Lannon
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Nov 15, 2014

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Implementing Nurse Driven Point Implementing Nurse Driven Point of Care Testing as a Chest Pain of Care Testing as a Chest Pain

Center Accredited within the Center Accredited within the Emergency Department Emergency Department

Presenters: Presenters:

Chris Vanni & Chris Vanni &

Kathryn LannonKathryn Lannon

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HistoryHistory::Who are the Sisters of St. FrancisWho are the Sisters of St. Francis

Congregation of the Sisters of St. Francis of Perpetual Adoration, Congregation of the Sisters of St. Francis of Perpetual Adoration, founded 1863 in Germanyfounded 1863 in Germany

Mother Maria Theresia Bonzel brought their mission to North America Mother Maria Theresia Bonzel brought their mission to North America in 1875in 1875

By 1940 the Sisters were operating nearly By 1940 the Sisters were operating nearly 80 hospitals, schools, nursing homes, 80 hospitals, schools, nursing homes,

and orphanages in 11 statesand orphanages in 11 states

Today, Sisters of St. Francis Health Services (SSFHS) operates 13 Today, Sisters of St. Francis Health Services (SSFHS) operates 13 hospitals in Indiana and Illinois, along with many other support hospitals in Indiana and Illinois, along with many other support companies and facilities, and employs over 16,000 peoplecompanies and facilities, and employs over 16,000 people

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Northern Indiana Region Northern Indiana Region Facilities Facilities

St. Margaret Mercy – Dyer, IN

St. Margaret Mercy – Hammond, IN

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Northern Indiana Region Northern Indiana Region FacilitiesFacilities

St. Anthony – Michigan City, IN

Franciscan Physicians Hospital Munster, IN

St. Anthony – Crown Point, IN

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Development of Curriculum Development of Curriculum In 2005, SSFHS partnered with IUPUI School of In 2005, SSFHS partnered with IUPUI School of

Industrial Engineering to exchange and share Industrial Engineering to exchange and share knowledge.knowledge.

SSFHS learn the Lean Six Sigma philosophy and SSFHS learn the Lean Six Sigma philosophy and methodology. methodology.

IUPUI learned healthcare and how to apply Lean Six IUPUI learned healthcare and how to apply Lean Six

Sigma to it.Sigma to it.

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Project Goals Project Goals

To reduce Turn Around Time for lab results pertaining to To reduce Turn Around Time for lab results pertaining to cardiac markers in the Emergency Departmentcardiac markers in the Emergency Department

Earlier intervention by Cath LabEarlier intervention by Cath Lab

Have an Emergency Department based lab to bring Have an Emergency Department based lab to bring revenue back to the Emergency Departmentrevenue back to the Emergency Department

Gain Chest Pain Center Accreditation Gain Chest Pain Center Accreditation

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Point of Care Testing Point of Care Testing (POCT)(POCT) in the in the Emergency DepartmentEmergency Department

Steps taken to develop a Point of Care Steps taken to develop a Point of Care Testing LabTesting Lab

Licenses and Certifications RequiredLicenses and Certifications Required

Training and Competency Training and Competency

Impact of Point of Care Testing Impact of Point of Care Testing

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Development Development

Contract between Biosite Instrumentations Contract between Biosite Instrumentations based on an executive decision to begin based on an executive decision to begin incorporating POCT in the Emergency incorporating POCT in the Emergency DepartmentDepartment

Physician studies and sits for the exam to Physician studies and sits for the exam to be Laboratory Directorbe Laboratory Director

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DevelopmentDevelopment

Laboratory Information Systems (LIS) Laboratory Information Systems (LIS) design and validate the interfacedesign and validate the interface

Biosite Instrumentation comparison studies Biosite Instrumentation comparison studies are completedare completed

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LicenseLicense

Hospital applies and receives “CLIA Hospital applies and receives “CLIA License”License”

Laboratory Manuals rewritten to fulfill CLIA Laboratory Manuals rewritten to fulfill CLIA requirements: General Lab, Safety, requirements: General Lab, Safety, EducationEducation

COLA inspection set up according to CLIA COLA inspection set up according to CLIA guidelinesguidelines

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Training and CompetencyTraining and Competency

Training Competency Programs Developed Training Competency Programs Developed

Proficiency testing set-up according to CLIA Proficiency testing set-up according to CLIA guidelinesguidelines

Nurses trained to be Laboratory technicians Nurses trained to be Laboratory technicians in the Emergency Department in the Emergency Department

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Reduction in Cost Reduction in Cost

Testing the five “cardiac markers” through Testing the five “cardiac markers” through POCT testing laboratories in the Emergency POCT testing laboratories in the Emergency Room show a decrease in direct costs.Room show a decrease in direct costs.

– Direct Cost thru Clinical LabDirect Cost thru Clinical Lab $12 per test $60 for five test$12 per test $60 for five test

– Direct Cost thru POCT Lab in EDDirect Cost thru POCT Lab in ED $4.20 per test $21 for reagent cartridge to run all five $4.20 per test $21 for reagent cartridge to run all five

teststests

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Turn Around Time Turn Around Time (TAT)(TAT)

Decrease in TAT for “cardiac markersDecrease in TAT for “cardiac markers– Reduced by 40 minutes (from 60 mins to 20 Reduced by 40 minutes (from 60 mins to 20

mins)mins)

Cath Lab notified 40 minutes sooner to Cath Lab notified 40 minutes sooner to begin faster interventions begin faster interventions

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Length of StayLength of Stay

Cardiac Patients who received POCT Cardiac Patients who received POCT showed a .5/day reduction in their overall showed a .5/day reduction in their overall Length of StayLength of Stay

This reduction allows critical care beds to This reduction allows critical care beds to free up quicker giving new cardiac patients free up quicker giving new cardiac patients the bedthe bed

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Financial Impact Financial Impact

Testing the five “cardiac markers” through Testing the five “cardiac markers” through POCT testing laboratories in the Emergency POCT testing laboratories in the Emergency Room show a decrease in direct costs.Room show a decrease in direct costs.

– Direct Cost thru Clinical LabDirect Cost thru Clinical Lab $12 per test $60 for five test$12 per test $60 for five test

– Direct Cost thru POCT Lab in EDDirect Cost thru POCT Lab in ED $4.20 per test $21 for reagent cartridge to run all five $4.20 per test $21 for reagent cartridge to run all five

teststests

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Projected Savings from POCTProjected Savings from POCT

With the reduction in direct costs the With the reduction in direct costs the hospital brings in an annual savings hospital brings in an annual savings – Savings over first 3 months Savings over first 3 months

$89,454$89,454

– Projected Annual Savings Projected Annual Savings $357,816$357,816

– Projected Savings over 3 yearsProjected Savings over 3 years $1,073,488$1,073,488

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Accreditation Accreditation

Point of Care Testing has assisted in the Point of Care Testing has assisted in the hospital becoming the first Chest Pain hospital becoming the first Chest Pain Accredited facility in Northern Indiana. Accredited facility in Northern Indiana.

Emergency Department POCT is now being Emergency Department POCT is now being implemented at other SSFHS facilities in the implemented at other SSFHS facilities in the Northern Indiana Region Northern Indiana Region

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Comments & QuestionsComments & Questions