P005: LABOR TIME ANALYSIS OF THE ROTATIONAL THROMBELASTOMETRY (ROTEM®)
Elizabeth Rindo, SRNA1, Patrick Ziemann-Gimmel, MD2, Allison A Goldfarb, ARNP, DNP, CRNA2, Bart Warne, CCP3, Derek Muehrcke, MD3; 1UNF, 2Sheridan, 3Flagler Hospital
Introduction: According to a recent study performed by the American Hospital Association, two-thirds of every dollar spent by hospitals goes to wages for health care providers (American Hospital Association, 2012). In order to be financially conscious it is important to analyze the labor cost of specific practices and procedures. ROTEM® is a viscoelastic point-of-care (POC) technology used to assess interactions of coagulation factors, inhibitors and cellular components during the phases of clotting and subsequent thrombolysis over time (Görlinger, 2015). A graphical representation of the ROTEM® can be used to evaluate what type, if any, blood products should be administered to patients experiencing coagulopathy. The purpose of this study is to investigate the workflow (cost) necessary to analyze a blood sample with a viscoelastic rotational thromboelastogram method (ROTEM®).
Methods: A stop -watch will be used to calculate the time it takes to run each point-of-care test. Several tests will be timed and the salary of the operator will be applied to estimate the cost of the labor. In addition, we will also calculate the time it takes to run a quality control test each week, and again, apply the respective salary of the operator.
Results: The average time to run a test (n=18) is 1min 13sec (+/- 87sec). It takes an experienced (n=12) provider an average time of 1min 20sec (+/-6.4sec) versus 1min 21sec (+/-20.2sec) for an inexperienced provider (p=0.876) to start the test. Quality control (n=4), done once weekly, takes a total time of 2h 31min 15 sec (+/-1h9min 53sec). This includes preparation 4min17sec (+/-1min42sec), mixing the reagents 1min 5sec (+/-19.8sec), documentation 2min 2sec (+/-10min 3sec) and re-mixing the agents to rerun the test after failure 3min 5sec (+/-5min 58sec). The huge majority of time is waiting for the quality control test to run 2h 22min 33sec (+/-1h 8min 14sec).
N refers to the number of test.
Discussion: There was no difference in the time it took an experienced provider versus an inexperienced to mix the reagents and start the test. This indicates that the mixing procedure is easy to do and quick to learn.
The mixing procedure only takes less than 90 seconds per test and is negligible in cost. The quality control requires a substantial amount of time, on average 2 ½ hours where most of the time spend is waiting for the test (downtime), when theoretically the provider can dedicate his/her time to another task.
The cost of the test including quality control and all supplies is approximately $235 (Ziemann-Gimmel et.al SCA 2015) without figuring in any cost savings from a reduction in blood component therapy.
Conclusion: Mixing and starting a test with ROTEM® is easy to learn and doesn’t require a large amount of time. Quality control, in contrast, requires a provider to be present for 2 ½ hours.