A systemwide blood gas laboratory at Mission St Joseph’s Hospital has resulted in positive outcomes for staff and patients alike.

Today, successful health care requires constant progression toward maximum efficiency. Health care practitioners must be able to adapt to change, such as mergers and new forms of medicine, in order to remain viable. In Asheville, NC, two area hospitals, Memorial Mission and Saint Joseph’s, recently formed a partnership to compete in the evolving western North Carolina health care market. This partnership provided both hospitals with additional resources and the ability to maintain quality health care while reducing expenditures.

As a result of this partnership, the respiratory care departments of both hospitals joined to become a systemwide respiratory care service. This service, under one director, was empowered to find ways to improve services and reduce costs.

Consolidating Resources

Prior to the partnership, the two respiratory care departments had operated separate arterial blood gas (ABG) laboratories. Both were spending a great amount of capital to operate these laboratories, which were in great need of upgrading. Physicians were requesting specialized tests that could not be performed with the present equipment. To complicate matters, given the partnership, interaction between the two hospitals had increased significantly and patients who were admitted to one hospital would frequently be moved to the other to receive the most appropriate treatment possible. For this reason, patient information had to be easily accessible from and interchangeable between both institutions. For the ABG laboratory to accomplish this and reduce costs, the new ABG system would have to be low-maintenance, user-friendly, and networked.

To start, the two laboratory supervisors chose a team of 11 individuals, including physicians, RCPs, sales and marketing people, and hospital administrative staff to work on the project. Working with the computer services department, the physician staff, materials management, legal services, and medical records, and pooling their knowledge, the team devised a list of feasible system options. The group was structured so the final determination on the system would be a joint decision between the ABG laboratory staff and the other hospital departments.

System Requirements

It was determined for the new system to work, it would have to include the following:

  • user-friendly equipment;
  • state-of-the-art technology;
  • upgradable equipment;
  • system security;
  • all-inclusive capitated cost-per-result contract;
  • money-back guarantee;
  • 5-year client/vendor partnership including service, technical support, software upgrades, biomedical engineering and staff training, continuing education, and equipment warranties; and
  • in-house program design and analyzer support.

    Blood gas analyzer requirements included:

  • benchtop and point-of-care capabilities;
  • analyte-panel customization;
  • ABG, electrolyte, and co-oximetry capabilities in one unit;
  • small sample volume;
  • low-maintenance requirements;
  • easy trouble-shooting; and
  • multilevel-user password protection.

    Data-management requirements included:

  • bidirectional capabilities in the hospital information system (HIS) and/or laboratory information system (LIS);
  • ability to share information between the two facilities and possibly physicians’ offices;
  • Health-level 7 (HL-7) computer interface capabilities–that is, a computer-
    formatting system for information reporting specific to the health care industry;
  • broad network capabilities;
  • fax modem;
  • multiworkstation capacity;
  • uninterrupted power supply and tape backup;
  • multilevel-user password protection;
  • custom-analyzer interfacing;
  • custom-reporting capabilities;
  • quality assurance management and documentation capabilities; and
  • audit and statistic programs.

    Several vendors could meet most of these requirements. To meet all of our needs, however, a vendor would have to be able to interface to an HIS or LIS; provide bidirectional interfacing; collect data from multiple blood gas analyzers and consolidate the information on one system; link blood gas analyzers into a single network; and monitor activity in all locations from one centrally controlled area.

    Finding A Vendor

    The laboratory supervisors contacted several vendors of blood gas equipment and conducted surveys to see what was working for their peers. Twelve hospitals were surveyed on the basis of their size or the fact that their respiratory care department offered services similar to those at Mission St Joseph’s. Some of the questions included:

  • what equipment do you use in the laboratory?
  • what is your opinion of the quality and operation of the equipment?
  • what do you see as the advantages and disadvantages of the equipment?
  • how does the equipment perform in a neonatal setting?
  • Is The Equipment User-Friendly?

    Upon compiling the survey answers, the possible vendors were immediately narrowed to three. To the team’s disappointment, however, none of the three vendors offered anything close to the hospitals’ needs. The vendors only offered systems that communicated within the walls of one facility, and they offered only American Society for Testing Materials (ASTM) interfacing. Information services preferred HL-7 interfacing because it was specifically designed for health care and is easy to program, whereas ASTM is primarily used in industry. The networked system we required appeared to be “vaporware”–that is, software that had not yet been developed.

    Nonetheless, the three vendors brought their analyzers and software to us for evaluation. The laboratory supervisors subsequently made site visits, touring the vendors’ facilities and hospitals that used their equipment, and assessing the technologies.

    As we conducted our research, the same problem continued to arise; none of the vendors could meet the networking needs of Mission St Joseph’s Health System. Most of the software that had been evaluated seemed difficult to operate. Some vendors were just beginning to explore the potential for networking blood gas analyzers and computer systems. One vendor suggested exploring software provided by a second party, which would mean dealing with two companies rather than one. We decided to continue to investigate our options.

    The original timeline to chose a vendor, 2 months, passed several times. Because the technology was evolving so rapidly, making a selection was almost impossible. Administration was advised of the situation and granted us several extensions based on the technical difficulties we were encountering. Finally, two of the site visits left an impression on the team. Out of all of the vendors, these two companies came closest to satisfying our requirements. Still, no system combination existed that married the hardware, software, interfacing, and networking we desired.

    During the evaluation process, the vendors were given the same criteria. The chosen vendor would have to provide an out clause and/or agree to pay a penalty for failure to provide HL-7 capabilities by a certain date as well as be able to provide low cost per sample. In addition to the previously listed criteria, we would have the right to cancel the agreement at any time, receive adequate trade-in allowances for the old equipment, and incite a penalty clause for the late delivery of goods. Warranty guarantees were to be provided as well as free software upgrades and biomedical engineering training for two primary operators.

    The CEO of one of the two vendors being considered met with the laboratory supervisors and promised that if his company’s software, interfacing, and networking did not work, he would find a system that would work at his company’s expense. He also offered a money-back guarantee. After a meeting of all parties, a contract was awarded to this vendor in November 1996. After the terms of the contract were determined, the system was approved by administration, purchasing, and legal services.

    Subsequently, the laboratory supervisors were sent to the company to train on the equipment. During training, it was discovered that the software provided would not meet the hospitals’ needs. The company was willing to act as “middleman” and meet with a computer software vendor of our choice that could meet our requirements–at the company’s expense, as promised. Contracts were successfully negotiated, technical problems were worked out between the two companies, and delivery of equipment and implementation were planned.

    System Components

    In choosing a system, organizations should anticipate future needs. For example, it was determined Mission St Joseph’s might want to ad an outpatient services department, so we chose a system that could handle the addition. Another important factor in choosing a system is to think of it as a whole, rather than to “underbuy” and purchase individual pieces that may soon be outmoded or inadequate for your organization’s needs.

    The system we chose consists of a main ABG laboratory outfitted with a server, a computer workstation, and two ABG analyzers. There are four satellite laboratories, each with a workstation and one analyzer. The main ABG, neonatal intensive care unit laboratory, and emergency department laboratory are located on Mission’s campus. The hospitals are networked via an interface engine, which allows bidirectional transfer of information between the campuses and the HIS. The interface is all-inclusive, which encompasses admission, discharge and transfer (ADT) transmissions, patient orders, results, and charges. The server has a fax modem that allows for customization and trouble-shooting by the vendor.


    It took 6 months to implement the system once one was chosen. Implementation was done in three phases: training of RCPs and technicians; linearity and correlation studies of the blood gas analyzers; and installation of the computer system. The vendor offered us 20 hours of training for 1 week at an area hotel, freeing staff from the usual distractions at the hospital and allowing them to concentrate.

    In implementing the system, we encountered several problems. The largest was coordinating our computer services department with the software vendor to configure the system proved difficult. It was imperative, however, for the two people in charge of this task to communicate in order for the system to work. Eventually we contacted the vendor and came up with a schedule for software configuration that worked for both parties.


    The new ABG laboratory system has resulted in excellent outcomes for patients and staff. Recently, both hospitals had College of American Pathologists inspections and passed with flying colors. The inspector was impressed with the quality of the system integration, the documentation, and the information we are able to obtain on screen.

    Staff now spends less time trouble-shooting problems with the analyzers and the automated QA module and more time at the patient’s bedside. Physicians are pleased with the selection of analytes and the shorter turnaround time for blood gas reports. The equipment has also proven to be reliable and to allow many customization options. Over the next 5 years, we anticipate saving approximately $250,000 in reduced service contracts for equipment, lower personnel costs, and free upgrades (included in our vendor contract).

    Terry Smith, RRT, is clinical coordinator of the respiratory care department, and Les Foss, RRT, is manager of the arterial blood gas laboratories, both at Mission St Joseph’s in Asheville, NC.