Recently, there has been increasing utilization of computers ranging from inexpensive microprocessors to large mainframe computers to generate interpretation of arterial blood gases, as well as to calculate derived parameters such as alveolar-arterial 02 gradients, base excess, bicarbonate and arterial-venous differences.
This has occurred in the midst of wide disagreement by physicians about the medical benefit of interpreting blood gas data in the laboratory rather than at the patients bedside.
Hingston et al recently reported that in spite of the fact that interpretations of arterial blood gases is widely taught in medical school and residency training programs, a test group of physicians erred too frequently on examination of acid-base disorders and disorders of oxygenation. More distressingly, the tested physicians were unaware of their limitations. This article has led to the tentative acceptance of laboratory-based interpretations as a reimbursable benefit by Blue Cross/ Blue Shield of California, similar to that of interpretation of pulmonary function tests and electrocardiograms.
A recent audit at Mercy Medical Center at Denver, Colorado, revealed a discouraging 33 percent prevalence of untimely or inappropriate therapeutic responses by physicians and house staff following a report of life-threatening blood gas level defined as a Po2 less than 50 mm Hg, Pco2 greater than 50, and/or a pH less than 7.30. Another audit at St. Joseph Hospital in Denver of identically-defined life-threatening arterial blood gas levels identified a patient population having a 27 percent in-hospital mortality rate. Thus, it would seem reasonable that emergency room patients and all hospitalized patients, as opposed to ambulatory patients, represent the population at risk and are in greater need of interpretation of blood gas levels. Be safe and sound with https://mycanadian-pharmacy.net My Canadian Pharmacy.
It is impractical and not cost-effective for a pulmonary specialist to be available for instant interpretations of blood gas levels 24 hours a day. Since the report of Cohen in 1969 showing that computerized interpretations of arterial blood gas levels was credible based on empirically-defined limits, progressively more sophisticated programs have been developed, which in most cases are more accurate and complete than those generated by the busily scribbling pulmonologist.
In addition to calculation of bicarbonate, base excess and oxygen saturation, now often included in blood gas analyzers, several different computer software programs that generate interpretations are now available. The better programs feature: 1) identification and flagging of severe values which helps initiate or coordinate protocol response by the health care team; 2) identification of impossible or unlikely data so corrections can be made; 3) formatting of the data to identify trends; 4) generation of differential diagnoses; and 5) suggestion of therapeutic direction, though this is controversial.
In our view, the most important benefits to patient care are those programs which help promote therapeutic action by alerting respiratory therapy and nursing personnel, as well as the responsible physician, when life-threatening conditions are flagged. We are convinced that pulmonary physician supervision and over-reading of computer-generated interpretations is a key feature leading to the optimal performance by the arterial blood gas laboratory and by the coordinated health care team. The followup audit at Mercy Medical Center in Denver following the establishment of a computerized pulmonary specialist-supervised system reduced the deficiencies identified by the initial audit to a 9 percent incidence.
It is our view that computerized interpretation and enhancement of arterial blood gas reporting is here to stay because of increasing evidence that such data management by a pulmonary laboratory, supervised by a pulmonary specialist, will be increasingly recognized as a benefit to patient care. Now that relatively inexpensive microprocessors can be programmed to do this effectively, it is a virtual certainty that the use of such devices will be widespread.