Utilization and cost analysis of bedside capillary glucose testing in a large teaching hospital: Implications for managing point of care testing

Elizabeth Lee-Lewandrowski, Michael Laposata, Karen Eschenbach, Carol Camooso, David M. Nathan, John E. Godine, Katherine Hurxthal, Joe Goff, Kent Lewandrowski

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

purpose: To study the use and cost of bedside capillary glucose testing in a large teaching hospital. patients and methods: In a prospective study of 40 inpatient units and 10 outpatient units at Massachusetts General Hospital, records were maintained by each unit of the date, time, operator, and results of patient and quality control tests. Cost analysis was performed using data from time studies, test tallies in logbooks, and hospital administration records. results: The number of glucose meters in the hospital increased from 10 to 54 over a 2-year period. In 1992, 67,596 tests were performed by the bedside method, representing 30.7% of all glucose measurements performed in the institution. The majority of tests (94.7%) were performed on inpatients, and 10.2% of all hospital admissions underwent bedside glucose testing. The impact on the number of glucose tests performed in the clinical laboratories was minimal, indicating that bedside glucose testing was added as an extra test rather than as a substitute for laboratory-based glucose measurements. The cost of bedside glucose testing was $4.19 per test compared with $3.84 in the clinical laboratory. The cost varied from one unit to another (median $5.52, range $3.08 to $48.16), an effect largely attributed to the difference in the volume of tests performed by different units. In seven high-volume units the cost per test was lower than the corresponding value in the laboratory. The cost of bedside glucose testing included labor (80.2%) and supplies (19.8%). The percent of costs attributed directly to patient testing was 57.7%, whereas the costs for all other related activities (training, quality control, and quality assurance) was 42.3%. conclusions: Bedside capillary glucose testing is a rapidly expanding technology and is performed on a significant percentage of hospital admissions. Bedside glucose testing is not inherently more expensive than centralized laboratory measurements but implementation on inefficient care units with low utilization can add substantially to the cost. Much of the excess cost of the bedside method can be attributed to the high costs of quality control and quality assurance, training, and documentation.

Original languageEnglish (US)
Pages (from-to)222-230
Number of pages9
JournalThe American Journal of Medicine
Volume97
Issue number3
DOIs
StatePublished - 1994
Externally publishedYes

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Teaching Hospitals
Costs and Cost Analysis
Glucose
Quality Control
Hospital Records
Inpatients
Point-of-Care Testing
Hospital Administration
Time and Motion Studies
Cost Control
General Hospitals
Documentation
Teaching
Outpatients
Prospective Studies
Technology

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Utilization and cost analysis of bedside capillary glucose testing in a large teaching hospital : Implications for managing point of care testing. / Lee-Lewandrowski, Elizabeth; Laposata, Michael; Eschenbach, Karen; Camooso, Carol; Nathan, David M.; Godine, John E.; Hurxthal, Katherine; Goff, Joe; Lewandrowski, Kent.

In: The American Journal of Medicine, Vol. 97, No. 3, 1994, p. 222-230.

Research output: Contribution to journalArticle

Lee-Lewandrowski, Elizabeth ; Laposata, Michael ; Eschenbach, Karen ; Camooso, Carol ; Nathan, David M. ; Godine, John E. ; Hurxthal, Katherine ; Goff, Joe ; Lewandrowski, Kent. / Utilization and cost analysis of bedside capillary glucose testing in a large teaching hospital : Implications for managing point of care testing. In: The American Journal of Medicine. 1994 ; Vol. 97, No. 3. pp. 222-230.
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abstract = "purpose: To study the use and cost of bedside capillary glucose testing in a large teaching hospital. patients and methods: In a prospective study of 40 inpatient units and 10 outpatient units at Massachusetts General Hospital, records were maintained by each unit of the date, time, operator, and results of patient and quality control tests. Cost analysis was performed using data from time studies, test tallies in logbooks, and hospital administration records. results: The number of glucose meters in the hospital increased from 10 to 54 over a 2-year period. In 1992, 67,596 tests were performed by the bedside method, representing 30.7{\%} of all glucose measurements performed in the institution. The majority of tests (94.7{\%}) were performed on inpatients, and 10.2{\%} of all hospital admissions underwent bedside glucose testing. The impact on the number of glucose tests performed in the clinical laboratories was minimal, indicating that bedside glucose testing was added as an extra test rather than as a substitute for laboratory-based glucose measurements. The cost of bedside glucose testing was $4.19 per test compared with $3.84 in the clinical laboratory. The cost varied from one unit to another (median $5.52, range $3.08 to $48.16), an effect largely attributed to the difference in the volume of tests performed by different units. In seven high-volume units the cost per test was lower than the corresponding value in the laboratory. The cost of bedside glucose testing included labor (80.2{\%}) and supplies (19.8{\%}). The percent of costs attributed directly to patient testing was 57.7{\%}, whereas the costs for all other related activities (training, quality control, and quality assurance) was 42.3{\%}. conclusions: Bedside capillary glucose testing is a rapidly expanding technology and is performed on a significant percentage of hospital admissions. Bedside glucose testing is not inherently more expensive than centralized laboratory measurements but implementation on inefficient care units with low utilization can add substantially to the cost. Much of the excess cost of the bedside method can be attributed to the high costs of quality control and quality assurance, training, and documentation.",
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