UTILIZATION AND COST-ANALYSIS OF BEDSIDE CAPILLARY GLUCOSE TESTING INA LARGE TEACHING HOSPITAL - IMPLICATIONS FOR MANAGING POINT OF CARE TESTING

PURPOSE: To study the use and cost of bedside capillary glucose testin g in a large teaching hospital. PATIENTS AND METHODS: In a prospective study of 40 inpatient units and 10 outpatient units at Massachusetts General Hospital, records were maintained by each unit of the date, ti me, operator, and results of patient and quality control tests. Cost a nalysis was performed using data from time studies, test tallies in lo gbooks, and hospital administration records. RESULTS: The number of gl ucose meters in the hospital increased from 10 to 54 over a 2-year per iod. In 1992, 67,596 tests were performed by the bedside method, repre senting 30.7% of all glucose measurements performed in the institution . The majority of tests (94.7%) were performed on inpatients, and 10.2 % of all hospital admissions underwent bedside glucose testing. The im pact on the number of glucose tests performed in the clinical laborato ries was minimal, indicating that bedside glucose testing was added as an extra test rather than as a substitute for laboratory-based glucos e measurements. The cost of bedside glucose testing was $4.19 per test compared with $3.84 in the clinical laboratory. The cost varied from one unit to another (median $5.52, range $3.08 to $48.16), an effect l argely attributed to the difference in the volume of tests performed b y different units. In seven high-volume units the cost per test was lo wer than the corresponding value in the laboratory. The cost of bedsid e glucose testing included labor (80.2%) and supplies (19.8%). The per cent of costs attributed directly to patient testing was 57.7%, wherea s the costs for all other related activities (training, quality contro l, and quality assurance) was 42.3%. CONCLUSIONS: Bedside capillary gl ucose testing is a rapidly expanding technology and is performed on a significant percentage of hospital admissions. Bedside glucose testing is not inherently more expensive than centralized laboratory measurem ents but implementation on inefficient care units with low utilization can add substantially to the cost. Much of the excess cost of the bed side method can be attributed to the high costs of quality control and quality assurance, training, and documentation.