Point-of-care glucose testing: system management and quality improvement at the 2,000 beds medical school hospital; 13-years’experience

Abstract

To evaluate the effectiveness of the management system for point-of-care glucose testing (POC Glucose) at the 2,000 beds medical school hospital by using the results of internal quality control (IQC), External Quality Assessment (EQA), as well as satisfaction surveys of doctors, nurses/operators and patients during the years 2007 to 2019. The method of this study was retrospective study to analyze IQC and EQA results of sites performing POC glucose testing, including inpatient wards and Outpatient Department (OPD), as well as results of satisfaction surveys of doctors, nurses/operators and patients. These data were categorized into three phases for quality development: Phase 1 (2007) which was prior to implementation of ISO 22870, and which utilized a single system for POC Glucose with IT connectivity, Phase 2 (2008 – 2014) which occurred after implementation of ISO 22870:2006, and finally Phase 3 (2015-2019); new technologies were used that resulted in the change to a new POC Glucose meter; and subsequent implementation of ISO 22870:2016.  Management review records of each year were reviewed to confirm the outcome of quality management in each phase. The finding revealed that the number of sites performing POC Glucose testing varied in number from 141 to 168 during 2007 to 2019.  IQC data of Phase 1 could not be found.  IQC results of Phase 2 evidenced that 45.4-99.5% of sites had a coefficient variation (CV) of IQC results < 10%.  In Phase 3 during 2015-2016, 99.9-100% of sites had a CV < 10%. During 2017-2019, the desirable level of precision was changed to CV < 6.7 %, and 98.3-99.2% of sites achieved this goal.  Regarding EQA, Phase 1 evidenced no EQA participation, in Phase 2 during 2008 – 2009, an Internal Quality Assessment was used instead of EQA. After joining EQA of College of American Pathologists (CAP) in the years of 2010 -2014, 75.9-100% of sites had EQA results within acceptable ranges. In Phase 3 during 2015 – 2016, 92.3-100% of sites had EQA results within acceptable ranges, and during 2017- 2019, 97.2–100% of sites had a QCC within acceptable ranges.  The overall satisfaction of all groups steadily improved year by year until the years of 2017 – 2019, with the overall satisfaction rate being more than 92%. Thus, it is concluded that the implementation of ISO 22870 leads to improvement of precision and accuracy of the POC glucose testing as well as doctor, nurse/operator and patient satisfaction. This reflects the achievement of the POC system management implemented in a tertiary care hospital.