A-407 Evaluation of i-STAT Error Rates and Associated Costs in Acute Care, Oncology, and Emergency Departments at a Major Academic Medical Center

Abstract Background Studies indicate that most quality errors in point-of-care testing (POCT) are operator-related, suggesting that targeted, continuous education could effectively reduce errors and associated costs. This study describes the error rates and types associated with i-STAT POCT in pediatric intensive care unit (PICU), neonatal intensive care unit (PICU), post-anesthesia care unit (PACU), oncology (RAB), and emergency department (ED). Findings from these units were also compared with the overall i-STAT error rate at the medical center. Methods A retrospective analysis was conducted on all i-STAT tests performed in the specified units between April 2023 and September 2024. The total numbers and types of errors from each unit were recorded (UniPOC®, Siemens) and compared to the overall error rate at the medical center. UniPOC® document types of error as cartilage handling, insufficient quantity (QNS), overfilled cartridge, unable to position samples, underfilled cartridge, environment, and other. For the cost analysis, it was assumed that each observed error necessitated at least one repeat test using a new cartridge. Since the cartridge-specific error rate for units with multiple cartridges was unknown, the cost analysis was conducted separately for each cartridge within each unit. The minimum and maximum costs from each unit were then summed to provide an overall range of cost estimates associated with the total error rate. Results At a medical center level, the overall error rate was 6%. Among the most common error types were "unable to position sample" (22%) and environment-related (19%) errors. The ED and NICU had identical total error rates of 8%, although leading causes differed. In the ED, the primary sources of error were environment-related (27%), followed by underfilled cartridges (17%), other causes (17%), and “unable to position sample” (16%). In contrast, the NICU most frequently encountered “unable to position sample” (43%) and underfilled cartridges (25%) errors. Similarly, the RAB and PACU had the same error rates of 3%, but the predominant sources varied. In the RAB unit, the primary source of error was “unable to position sample” (30%) vs other causes (39%) and environment-related (24%) errors in the PACU. Notably, the PICU exhibited significantly higher error rates of 18%, which can be ascribed to the inconsistent test volume observed each month (range, 4-138; median, 25). The primary sources of error in this unit resembled patterns observed in NICU, with the most common being “unable to position sample” (28%) and underfilled cartridges (28%). The overall estimated cost incurred by the medical center due to the total quality error associated with all the units included in the study ranged from $17,859.21 to $30,450.42. Conclusion The study identified patterns in the sources of error across the examined units, which can be leveraged to develop targeted educational interventions and consultations aimed at reducing quality errors and avoidable associated costs.