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Original Research |

An educational intervention optimizes the utilization of arterial blood gases across intensive care units from different specialties: a quality improvement study

Carlos D. Martínez-Balzano, MD; Paulo Oliveira, MD; Michelle O’Rourke, DAP ACBP-BC; Luanne Hills, BS RRT; Andrés F. Sosa, MD
Author and Funding Information

No conflicts of interest are reported.

No external funding was used for the preparation of this manuscript.

1Division of Pulmonary, Allergy and Critical Care Medicine. Department of Medicine. University of Massachusetts Medical School, Worcester, MA

2Department of Nursing, UMass Memorial Healthcare Center, Worcester, MA

3Department of Respiratory Care, UMass Memorial Healthcare Center, Worcester, MA

Corresponding author: Andrés F. Sosa, MD. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine. University of Massachusetts Medical School. 55 N Lake Ave, Worcester, MA 01655.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.035
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Abstract

Background  Arterial blood gas (ABG) overutilization leads to increased costs, inefficient use of staff work-hours, patient discomfort and blood loss. We developed guidelines to optimize ABG utilization in the intensive care unit (ICU).

Methods  ABG utilization guidelines were implemented on all adult ICUs in our institution: three medical, two trauma-surgery, one cardiovascular and one neurosurgical ICU. While relying on pulse oximetry, we encouraged the utilization of ABGs after an acute respiratory event or for a rational clinical concern, and discouraged obtaining ABGs for routine surveillance, after planned changes of PEEP or FiO2 on the mechanical ventilator, for spontaneous breathing trials, or when a disorder was not suspected. ABG numbers and global ICU metrics were collected before (year 2014) and after the intervention (year 2015).

Results  We saw a reduction of 821.5 ± 257.4 ABGs/month (41.5%) or approximately 1 ABG/patient/mechanical ventilation day at each month (43.1 %) after introducing the guidelines (p <0.001). This represented 49L of saved blood, a reduction of $39,432 in the costs of ICU care and 1,643 staff work-hours freed for other tasks. Appropriately indicated tests rose to 83.4% from a baseline 67.5% (p= 0.002). Less than 5% of inappropriately indicated ABGs changed patient management in the post-intervention period. There were no significant differences in mechanical ventilation days, severity of illness or ICU mortality among the two periods.

Conclusion  The large scale implementation of guidelines for ABG utilization, reduced the number of inappropriately ordered ABGs over seven different multidisciplinary ICUs, without negatively impacting patient care.


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