Organizations generally consolidate services to improve efficiency and reduce expenses. In the case of point-of-care (POC) viscoelastic testing, however, hospitals may achieve better results by broadening service delivery.
“Viscoelastic testing is an interesting circumstance for point-of-care directors,” says Dr. Chris Farnsworth, associate professor at the Washington University School of Medicine and medical director of the Clinical Chemistry Point of Care Testing, Toxicology, and Special Pathogens Laboratory. In his role, he is often expected to reduce the volume of POC testing, both because it’s more expensive than in-lab testing and because laboratorians prefer to maintain control of lab testing processes.
However, the time-to-result factor significantly changes the paradigm for viscoelastic testing, which can provide critical insights during surgical procedures. Patients who experience significant bleeding during surgery are often transfused as a first-line defense—a therapy that is associated with higher morbidity and increased risk for serious postoperative complications1.
Viscoelastic testing allows physicians to test for coagulopathy at the onset of significant bleeding to identify and correct the specific deficiencies causing the bleeding. The faster clinicians can apply a targeted therapy, the fewer blood products administered.
“One of the core tenets of point-of-care testing is: Is the rapid result worth it? Is the juice worth the squeeze? This is potentially one of the circumstances where it really is worth the squeeze.”
Targeted Bleeding Management
Prior to implementing viscoelastic testing at the point of care, the accessibility to results to guide patient care decisions used to be a time-consuming process.
“In a patient that's bleeding actively, that's way too long. By the time you have the result, you have a completely different patient in front of you,” Dr. Birgenheier says.
Using point-of-care viscoelastic testing, Dr. Birgenheier says physicians were able to diagnose and apply targeted therapy to treat the bleeding within 5-10 minutes. This changed the treatment approach from blanket transfusion to targeted bleeding management.
“This allows us to look at an individual patient and [evaluate] their current clot-making ability based on a test instead of just a visual assessment of the field,” Dr. Birgenheier says.
Downstream ROI
Fewer inappropriate transfusions can improve clinical outcomes. In a study of more than 605,000 patients2, the implementation of a health-system-wide PBM program with targeted bleeding management resulted in a 28% reduction of in-hospital mortality and a 15% reduction in length of stay. In addition, it decreased blood product transfusions by 41%.
A study of elective, non-cardiac surgical procedures3 helps quantify the economic burden of transfusion-related complications. Inappropriate RBC transfusion appears to be common, the study concluded, and it results in hospital costs that are almost $10,000 higher on average than for non-transfused patients. Hospital stays for inappropriately transfused patients are also 1.6 times longer, averaging 10.6 days versus 6.7 days for non-transfused patients.
After implementing viscoelastic testing at the University of Utah, the Technology Assessment Committee reviewed the data on transfusions pre-and post-implementation and volunteered to purchase four more viscoelastic testing analyzers.
“They had seen the downstream effects of cost savings, transfusing patients less, and fewer complications in the postoperative period,” Dr. Birgenheier says. “Just by seeing that data, then it wasn't me making the case anymore, it was the hospital wanting to acquire the equipment.”
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