(1538) Implementation of a Resuscitation Blood Gas: A Cost-Effective Alternative to Point-of-Care Testing

Introduction: Point-of-care (POC) laboratory testing is highly valued in critical care settings for its rapid turnaround time. However, initial investment and annual fixed costs associated with POC testing may be a barrier to implementation for some institutions. Our hospital system developed and implemented the Resuscitation Blood Gas (RBG) protocol with the goal of approximating the speed of traditional POC testing by leveraging existing equipment in a central laboratory paired with several operational modifications.

Methods: The RBG protocol leverages blood gas analyzers in a central laboratory for comprehensive analytes traditionally found on POC testing: simplified blood gas, electrolytes, hemoglobin, lactate, glucose, and creatinine. These tests are flagged and prioritized by the lab. Results are populated automatically into the electronic medical record without delay for typical “critical results” pathways. The initial rollout required limited educational training directed toward the emergency department, intensive care units, and operating rooms.

Results: Since the implementation of the RBG protocol in 2021, its use has expanded exponentially across the institution. In our 505 inpatient bed hospital, over 1500 RGBs were ordered in the single month of April 2024. The RBG protocol has consistently demonstrated a turnaround time of 9 minutes from collection to results reported, saving approximately 20 minutes when compared to matched component analytes via traditional laboratory panels. Most commercially available POC systems require an initial investment averaging $35,000 per machine plus ongoing costs for disposables, calibration, and training. In comparison, the RBG protocol was implemented without any financial expenditure by the institution.

Conclusions: The RBG protocol provides timely, actionable results with no additional costs to the institution or patients. The improvement in efficiency has demonstrated a substantial impact on the management of undifferentiated, decompensating, and acutely ill patients across the hospital. The clinical and economic benefits of the RBG protocol highlight its potential for widespread adoption in critical care settings, especially where costs of POC testing are potentially prohibitive to their implementation.