March 8, 2012

‘Coag on a Cart’ offers real-time lab test results

Featured Image

Phillip Denton, medical technologist in Diagnostic Laboratories, places a patient sample on the TEG (thromboelastography) instrument for a platelet study. (photo by Anne Rayner)

‘Coag on a Cart’ offers real-time lab test results

When lab tests are required for procedures and surgeries performed in operating rooms, samples are traditionally sent to a lab within the hospital.
Clinicians then wait for results. But in an OR setting, scenarios can change minute to minute.

Thanks to Coag on a Cart, a new program at Vanderbilt University Medical Center, real-time data is now available to the medical team for use in liver transplant cases.

Three diagnostic instruments that perform select testing to help determine the patient’s ability to form a clot have been grouped together to create a mobile lab.

Seven highly trained medical technologists operate the machines.

“The tests that they are performing are rarely done outside of a lab setting,” said Arnulfo Delgado, director of Diagnostic Laboratories at Vanderbilt. “Essentially, we are bringing the lab to the OR.

“We now have the ability to reduce the amount of wait time, which has had a positive impact on patient care,” said Delgado. “Seventy-five percent or more of the decisions that physicians make are based on lab tests. Nothing beats being right there in the OR and giving them real-time results.”

In the four months that the program has been running, 44 cases have benefited from the new technology.

Projections call for 116 cases to use Coag on a Cart in the new fiscal year that begins in July.

“This has been a way to bring the lab to us and it has really been a phenomenal change,” said Michael Pilla, M.D., associate professor of Clinical Anesthesiology and associate director of the Anesthesiology Residency Program. “Overall, it has improved patient care and allowed us to more judiciously choose what our next steps will be.

“In many liver transplant cases, we don’t have a lot of time. This is a surgery where you can go from no blood loss to massive blood loss in a blink of an eye,” said Pilla. “Coag on a Cart provides a level of comfort. We have precise information that will guide our clinical decision making in real time.”

The three instruments that are combined to create a mobile laboratory include: Sysmex pocH100i Hematology Analyzer (which provides hematocrit and platelet counts); Stago STA Satellite Hemostasis System (for Fibrinogen, Prothrombin Time or PT and Partial Thromboplastin Time of PTT); and a Haemoscope TEG Instrument (for platelet studies).

The concept for this program came in 2008 with the arrival of Michael Laposata, M.D., Ph.D., Edward and Nancy Fody Professor and executive vice chair of Pathology, Microbiology and Immunology.

“All the pieces fell into place when I arrived at Vanderbilt because it is so collaborative and embraces innovation,” said Laposata. “Vanderbilt was smart enough to know the impact this type of change would have on patient outcomes.

“What was most clear upon first use was that surgical procedures were running more smoothly, which was translating to quicker patient recovery,” he said. “The way we manage these testing devices, we have cut out steps, reduced run and wait times for tests while providing instantaneous communication.

“From my perspective, this is just phase one,” said Laposata. “We will learn how to adapt this for use in other circumstances.”

Although Coag on a Cart is currently offered only for liver transplantations, there is a growing interest to use it for additional disciplines throughout the Medical Center.