SESSION TITLE: Cost and Quality Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: The purpose of our study is to shed light on the role peripheral VBGs have in the internal medicine and critical care community, in regards to evaluation of the patients in the triage setting.
METHODS: Questionnaires were distributed electronically to 40 internal medicine residents and attendings within our training program whiched asked the following questions: 1. Has a peripheral venous blood gas (VBGs) ever altered the management of a patient? 2. What do you feel is the most important value in peripheral VBGs? 3. Do you feel comfortable understanding the values presented in a peripheral VBG? 4. Do you feel the emergency department performs too many VBGs? 5. Have you ever ordered a peripheral VBG? If yes, what was the indication? All surveys, once answered by residents/attending were returned to a set location within the hospital ensuring that all data was collected anonymously.
RESULTS: In summary, 25% of residents felt the results of a peripheral VBG, changed their management of patients transferred from the emergency room. Fifty-two percent of those pollled felt that pH was the most important value in VBG analysis, with only 10% indicating that pCO2 was an important value. 50% percent of residents felt comfortable understanding the values presented in this analysis, explaining why only 12.5% of those surveyed indicated that they have ever ordered a peripheral VBG on any single patient throughout their training.
CONCLUSIONS: Regardless of the clinical role of VBGs, there is dyssynchrony between its value between emergency room physicians and those trained in internal medicine. These results are alarming considering how critical a patient’s acid-base status is in dictating management. The cost benefit of such a test must be taken into account if it is not valued or understood by the physicians that are asked to continue care after the triage period.
CLINICAL IMPLICATIONS: These results dictate that both emergency room physicians and internists need to revisit the published data and come to a consensus about the type of patient that would benefit from a VBG over the more invasive study. Consensus is needed in order to eliminate cost burden, and more importantly improve the transition of care in patients presenting with conditions in which acid-base status is needed for further management.
DISCLOSURE: The following authors have nothing to disclose: Peter Abdelmessieh, Mina Bushra
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