Point-of-care Glucose Testing: Thirteen-year Experience of Quality Improvement at the 2,000 Bed Medical School Hospital

Abstract

To evaluate the effectiveness of the management system for point-of-care (POC) glucose testing at the 2,000 bed medical school hospital, the results of Internal Quality Control (IQC) and External Quality Assessment (EQA) were analyzed, as well as satisfaction surveys of doctors, nurses/operators and patients during the years 2007 to 2019. This study was a 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 were analyzed. These data were categorized into three phases of quality development: Phase 1 (2007) prior to implementation of ISO 22870, and which utilized a single system for POC Glucose with IT connectivity, Phase 2 (2008 - 2014) after implementation of ISO 22870 : 2006, and finally Phase 3 (2015 - 2019); with new technologies 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 findings 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 was unavailable. IQC results of Phase 2 were 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) during 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 Quality Cross Check (QCC) by CAP within acceptable ranges. The overall satisfaction of all groups steadily improved year by year until the years 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 satisfaction of doctor, nurse/operator and patient. This reflects the achievement of the POC system management implemented in a large tertiary care hospital of a medical school.