Description:
Franklin Square Hospital Center (FSHC) is a 350-bed, full-service, acute and sub-acute care community teaching hospital located in Eastern Baltimore County in Maryland. Since its founding in 1898, the hospital has been at the forefront of primary care services and advances in medicine, surgery, and specialty care. It is currently the fifth-largest hospital in Baltimore, and one of the busiest hospitals in cardiology, emergency medicine, general medicine, obstetrics, and oncology. FSHC has been awarded the high-level designation of a Teaching Hospital Cancer Center by the American College of Surgeons.

FSHC is owned by MedStar Health, a $2.7 billion non-profit healthcare organization and community-based network of seven hospitals and other healthcare services in the Baltimore-Washington region. MedStar Health is a member of Novation, a national healthcare alliance serving the purchasing needs of over 2500 members and affiliates in the United States.

Emergency Care:
FSHC has the second largest and busiest Emergency Departments in the state, serving over 92,000 emergency patients in 2004, and increasing steadily. Significantly, FSHC provides the highest proportion of pediatric emergency services among hospitals in Baltimore County. Sixty percent of all hospital admissions are routed through the Emergency Department.

Challenge:
In March 1999, the Emergency Department at FSHC doubled in size from 34 to 68 beds to meet the increasing demand for emergency services within its community. In order to accommodate the increasing Emergency Department patient volume, the overall patient length of stay had to be reduced. A key to achieving this goal was to significantly decrease the turnaround time for laboratory tests while at the same time maintaining uncompromising standards of quality.

Solution:
FSHC decided to revamp their ER testing protocol and implement point of care testing directly in the Emergency Department. Toward that end, the Clinical Pathology Department created an ED Stat Lab to operate independently from the main laboratory. At the same time, the hospital brought in a team of ER physicians who steered the hospital toward purchasing two Nova Stat Profile analyzers for the new ER POC testing program.

In 2004, FSHC upgraded to Nova Stat Profile Critical Care Xpress (CCX) analyzers. According to Shirley Bartynski, POCT Coordinator at Franklin Square, the Nova CCX analyzers impressed the ER medical staff by their broad whole blood test menu -- including the Basic Metabolic Profile, BUN, and creatinine -- and precise correlation with lab methodology. Among other key CCX features was its small sample size, important for the growing pediatric patient population, and the availability of lactate that is part of a new test protocol being implemented for sepsis.

Later in 2004, based on the positive experience in the ER Stat Lab, a satellite laboratory was created in the new Harry and Jeanette Weinberg Cancer Institute where a Nova CCX analyzer was installed to provide rapid test turnaround time for critical diagnostic testing.

Benefits Realized:
With the installation of the Nova analyzers in the ER, the total patient turnaround time from sampling to verification of results was reduced to 6-7 minutes. This not only includes all Stat Profile tests but CBCs, urine dipstick, and pregnancy testing (HCG) as well. This dramatic reduction in turnaround time has been a primary factor for the steady increase in ER patient volume at FSHC since 1999. Moreover, after just the first five months of operation, the ED Stat Lab increased its revenues per 24 hours by more than 25%.

Since the ER is in close proximity to the laboratory, medical technologists employed by the laboratory can perform POC testing and verify results so that the laboratory continues to maintain control of the process. Once all POC test results are verified, they are combined and transmitted to the hospital's SoftLab® Laboratory Information System.

While the new ER POC program had been limited to the first two shifts, a third shift was added in 2005 to provide round the clock POC testing in the ER.