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Is the future of ER Nursing I-stats?

Nurses   (1,030 Views | 20 Replies)

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Is the future of ER Nursing constantly obtaining i-stats? If so, it was fun while it lasted but I'm out this specialty in about two years. 

Getting i-stats to me is so time consuming.  Why not just hire enough lab techs so that when we get the blood and send it, they can hurry up and run the tests or i-stats in lab? Why does everything have to be done by the NURSES!!!!!!!!??????

 

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I’m confused.  I-STATs are very easy.  It’s not the future, it’s the present.  It’s not time consuming.  I put my blood in and go do other things while I wait for results.  2 minutes is not long.  

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adventure_rn is a BSN and specializes in NICU, PICU.

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Idk, I love iSTATs. My new hospital doesn't have them and it drives me nuts. I don't think that hiring more lab staff would speed up the process because the limiting factor is the amount of equipment that they have during really busy times of day (i.e. 5 AM).

Personally, as a nurse, I find that it's way faster to run my own iSTAT than it is to have to walk it over to the tube station and wait for the labs to be sent off. Plus, I love the instant gratification of knowing my lab results right away; I prefer that over waiting around, sometimes for 30+ mins, to get my results.

To save time, I do my labs first thing when I'm with the patient. That way, I can finish up whatever I'm doing while the iSTAT is running. I don't know about the workflow in the ED, but I try to squeeze in my assessment and whatever other nursing cares I need to do while I wait for the iSTAT to run. Result: no time lost.

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13 hours ago, LovingLife123 said:

I’m confused.  I-STATs are very easy.  It’s not the future, it’s the present.  It’s not time consuming.  I put my blood in and go do other things while I wait for results.  2 minutes is not long.  

not all i-stats take 2 minutes long to complete. And supposedly it's not as accurate so the same testing must be done in lab anyway. I prefer to collect tubes and send it off and let lab do it. And I even feel the same regarding urine dips.  . 

In some ERs there's not enough i-stat machines for the size of ER and it's like adding just one more extra thing for the nurses to do.  

The straw that breaks the camel back.  None of the stuff is hard but keep adding one little small task on top of another simple task on top of another easy task. 

 

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12 hours ago, adventure_rn said:

Idk, I love iSTATs. My new hospital doesn't have them and it drives me nuts. I don't think that hiring more lab staff would speed up the process because the limiting factor is the amount of equipment that they have during really busy times of day (i.e. 5 AM).

Personally, as a nurse, I find that it's way faster to run my own iSTAT than it is to have to walk it over to the tube station and wait for the labs to be sent off. Plus, I love the instant gratification of knowing my lab results right away; I prefer that over waiting around, sometimes for 30+ mins, to get my results.

To save time, I do my labs first thing when I'm with the patient. That way, I can finish up whatever I'm doing while the iSTAT is running. I don't know about the workflow in the ED, but I try to squeeze in my assessment and whatever other nursing cares I need to do while I wait for the iSTAT to run. Result: no time lost.

if the limiting amount is equipment, get lab more equipment. Problem solved. Let lab do it. 

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I assume your complaint is doctors ordering I-stat  frequently  or even routinely which can take more nursing time than just ordering labs on the computer?   I assume you mean you prefer getting your own labs when you start an IV and sending them to the lab.

You may have a justifiable reason to be annoyed. Especially if there aren't enough I-STATs, and as you mentioned they order lab draws if the numbers are wonky.

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3 hours ago, gcupid said:

not all i-stats take 2 minutes long to complete. And supposedly it's not as accurate so the same testing must be done in lab anyway. I prefer to collect tubes and send it off and let lab do it. And I even feel the same regarding urine dips.  . 

In some ERs there's not enough i-stat machines for the size of ER and it's like adding just one more extra thing for the nurses to do.  

The straw that breaks the camel back.  None of the stuff is hard but keep adding one little small task on top of another simple task on top of another easy task. 

 

But the lab takes so long.  When you need a stat result, you have one quickly. The lab can take an entire hour to result a STAT lab.  It took them 7 hours to result a routine potassium lab for me the other day.  
 

I feel like you are missing the point of I-STATS.  You use them for STAT results. If I’m trying to figure out oxygenation issues, I’m not waiting an hour.  And that’s provided the lab doesn’t lose it or “accidentally” send it out as routine.  

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dream'n has 27 years experience as a BSN, RN and specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

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On 12/22/2019 at 1:02 PM, LovingLife123 said:

But the lab takes so long.  When you need a stat result, you have one quickly. The lab can take an entire hour to result a STAT lab.  It took them 7 hours to result a routine potassium lab for me the other day.  
 

I feel like you are missing the point of I-STATS.  You use them for STAT results. If I’m trying to figure out oxygenation issues, I’m not waiting an hour.  And that’s provided the lab doesn’t lose it or “accidentally” send it out as routine.  

If the lab is taking too long to run STATs, then that is an issue that the lab needs to solve.  It should not be pushed on nursing like everything else is.  Sometimes it seems that any issue another department encounters, the answer is "we'll have the nurses do it" instead of fixing the problem in the responsible department.

Rooms not being turned over quickly enough by housekeeping, "we'll have the nurses pick up the slack." Not enough pharm techs to bring up the urgent medication, "we'll have the nurse run down for it."  Not enough transport personnel, "we'll have the nurses transport."

 

Edited by dream'n

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Rose_Queen is a BSN, MSN, RN and specializes in OR, education.

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28 minutes ago, dream'n said:

If the lab is taking too long to run STATs, then that is an issue that the lab needs to solve

But an iSTAT can give lab results in 2 minutes. It’s not that the lab takes too long but that their equipment takes much longer to get to the results. My background is cardiac surgery. I can guarantee you we aren’t going to give our massive dose of heparin and then sit for 30-45 minutes for the lab to have the time to transport the tubes and get them into the machine for the length of time they need to be there then call us while we sit around twiddling our thumbs. No, we’re going to run an iSTAT result and know in 2 minutes if it’s safe for us to go on cardiopulmonary bypass without clotting off the circuit. 

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4 hours ago, Rose_Queen said:

My background is cardiac surgery. I can guarantee you we aren’t going to give our massive dose of heparin and then sit for 30-45 minutes for the lab to have the time to transport the tubes and get them into the machine for the length of time they need to be there then call us while we sit around twiddling our thumbs. No, we’re going to run an iSTAT result and know in 2 minutes if it’s safe for us to go on cardiopulmonary bypass without clotting off the circuit. 

All of our orders are STAT. And unless our patient is unlucky enough to qualify for some kind of Code This or Code That, it will be one RN doing all this simple little non-time-consuming STAT stuff that starts getting ordered as soon as they check in.

iStats are great. What isn't great is when ever-more things are added to the same list of things to be done in the same time-frame by the same (one) person. And expectations are not reviewed to see if anything can be pared down. It's just more...and a little more, and a little more, and a little more, and...(more)...

And more.

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tacticool has 3 years experience and specializes in BSN, RN-BC, NREMT, EMT-P, TCRN.

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You're in the ED. It's not the floor like in MedSurg. You have the advantage of having diagnostic info in your hands in MINUTES. I wish I had this ability as I currently do not work in the ED. We have to draw our own labs and tube them to the lab. I don't mind drawing my labs. I would say to you that I relish your ability to have the info so quickly.

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PeakRN specializes in Adult and pediatric emergency and critical care.

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Point of care testing has been the standard of care in the ED for a long time, and honestly any ED that isn't using them is at least a decade behind modern practice. Istats are used in EDs, ORs, ICUs, HEMS/CCT, and are beginning to make their way into EMS.

Like any machines iStats and EPOCs have limitations. They are a whole blood sample rather than a serum or plasma sample, so if a patient is hemoconcentrated or dilute then you will get a different value that the lab on many tests, this isn't an issue of accuracy but rather just a function of the methodology.

If you are running a grossly hemolyzed sample, one that has been sitting on the counter to long, was drawn in the wrong tube, and so on then you are going to get bad results. This would happen in the lab as well. While we cannot visually grade or measure free hemoglobin in the ED for hemolysis, we do get the benefit of knowing how easy or difficult a draw was.

POC testing (whether lab, ultrasound, transcutaneous CO testing, and so on) has a lot of benefits. It allows us to make faster decisions resulting in better care. My patient isn't on old vent settings for 30 minutes while I wait for a gas, they aren't sitting in the ED for 45 minutes with a NSTEMI while I wait for a trop, they aren't lying in bed with dead gut while I wait for a lactate, I don't find out my ionized calcium was 0.6 after we called the code, et cetera.

POC testing quicken care in general too, not just in ways that necessarily improve medical outcomes. The POC preg allows us to get imaging sooner, that urine dip gets low acuity UTIs out of fasttrack in minutes, ultrasound lets us get an abscess drained and out of the ED in well under an hour.

Providing patients that level of rapid assessment and stabilization is a big part of good ED nursing.

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