Description:
St. Joseph's Women's Hospital is a 250-bed, publicly held, not-for-profit, community hospital located in Hillsborough County in Tampa, FL. Among the most active areas is the 50-bed NICU which consistently maintains an occupancy rate of >95%. St. Joseph's Women's is a member of BayCare Health Network, a group purchasing organization consisting of 16 hospitals/medical centers in the greater Tampa area.

Challenge:

• To reduce the amount of blood required to perform testing on newborns.
• To reduce turnaround time required when sending blood samples to the laboratory. Sending out tests required a delay of several minutes for ABGs and approximately 2 hours for electrolytes and chemistries.

Solution:
St. Joseph's Women's installed Nova CCX analyzers in the NICU and Labor & Delivery Lab over a 6-month period in 2003, and added a pHOx Plus L analyzer in the NICU in late 2004.

According to Nancy Wilkes, Director of Cardiopulmonary Services, "prior to installation of the Nova analyzers, i-STAT systems were evaluated. The i-STAT cartridges were expensive and caused accuracy issues." With the i-STAT cartridges, multiple tubes and several mL of blood were required to perform a comparable test panel. In the CVOR, i-STAT cartridges were used 4-6 hours per day/4 days per week resulting in less testing capacity and a 2.5X expenditure over budget.

Key Tests Performed:

• Ionized Magnesium (primarily for cardiology)
• BUN/Creatinine
• Lactate (increasing utilization and dependency using cord blood)

Benefits Realized:

• REDUCED AMOUNT OF BLOOD TO TREAT NEWBORNS
  – Drawing and transporting blood for testing outside the NICU required several mL of blood every draw
  – The CCX requires only a single draw of 100-200 µL for the complete test panel required
  – ABGs require just 50 µL on the pHOx Plus L
• REDUCED TURNAROUND TIME
  – POC testing allows for immediate evaluation and adjustment of treatment. In the NICU, time is more critical than in units with older children or adults.
  – Five full time neonatologists on staff can treat NICU patients immediately

Wilkes added that “the RTs run the lab and perform all of the phlebotomies. The RT labs are under CLIA license and operate under review of clinical laboratory.”

System Configuration: