In 2018 Becton Dickinson, Specimen Management Systems, European Medical Affairs (SMSEMA) embarked on trying to identify stakeholders’ pains in POCT with the setting up of scientific advisory board (SAB). The SAB was a mix of laboratory, Emergency Department (ED), ICU and nursing consultants, to share best practice, with a focus on the preanalytical stage of POCT.
One of the key concerns identified was the impact of hidden errors in POCT, particularly with blood gas (BG)analysis and the impact on patient diagnosis, patient care and hospital resources. It was widely felt that there was a high error rate of potassium results, due to haemolysis and that this needed to be investigated. Dr Tracy Ellison, the Director of SMSEMA suggested a multicentre study analysing ED BG and core laboratory haemolysis and potassium results data, to identify the potassium error percentage.
Three of the laboratory SAB members agreed to undertake the study and write a joint paper but due to the Covid pandemic this work was delayed. In 2021, Anthony Malpass FSCCT, European Clinical Project manager, SMS EMA, proposed delivering two educational workshops on the potential issues of hidden errors in BG, with one focusing on misdiagnosis, for the European Society of Emergency Medicine, EUSEM and the other on potassium errors for Euromedlab. The lesson plan for the Euromedlab educational workshop enabled the joint approach to the data collection, including the inclusion and exclusion criteria. This gave the impetus to recommence work on the paper.
On the day of the Euromedlab workshop in Munich 2022, the speakers met for a final preparation and to go through their joint presentation and individual data sets, it was noted that each sites data sets had approximately a 9% error rate between the ED and core laboratory potassium results. All agreed this was potentially as lot of patients being misdiagnosed impacting upon the care and treatment they would receive, and it was important to complete the paper for publication.
Unfortunately, due to the change of focus on workstreams within BD, the POCT project was put on hold and the SAB dissolved in September 2022 and Anthony Malpass left BD.
However, Anthony felt the paper was too important to not be completed and told BD he wished to remain in communication with the SAB members and received confirmation that BD has no issue with him doing so. As a result, the SAB members and Anthony kept in touch. Professor Peter Luppa, Dr Antonio Buno Soto and Dr Andrie Tintu having several conference calls with Anthony and the work on the paper continued. Once the initial draft was completed, it was shared with all the former SAB members for their input, which was forthcoming and most welcome and resulted in the finished paper. Dr Bendan Meyer, Associate Direction Medical Affairs, EMEA, was liaised with regarding open access publication and very kindly he and BD made this possible
The key takeaway from the paper is that no matter how well maintained a Blood gas analyser is, how well its managed or where it is located, it appears that 9% of blood samples, are not true representations of the patient in vivo blood supply. As suggested in the paper this may be due to the time pressures on staff in ED and the need to take blood samples as soon as possible, thus creating preanalytical errors, particularly with haemolysis impacting potassium levels and patients care.
Anthony Malpass, former European Clinical Project Manager, BD IDS Medical Affairs Europe, Lean Sigma Black Belt, Fellow Society of Critical Care Technologies
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