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If you're frustrated when patients on warfarin fail to get their prothrombin times checked on schedule, Dr. Ronald Hirsch recommends that you do your own patient monitoring, in house.
One patient with a prosthetic mitral valve “was supposed to get his prothrombin checked monthly at the hospital lab. When he came into the office after a 6-month absence with no intervening tests, I realized that it was time to bring prothrombin time testing into our office,” said Dr. Hirsch, an internist in Elgin, Ill.
Dr. Hirsch contacted a Roche Diagnostics representative and saw a demonstration of the CoaguChek device. “We ordered a machine, set up a protocol for testing and quality control, and developed chart templates. Since we were already Clinical Laboratory Improvement Act waived, there was no additional certification needed,” he said in an interview.
The seven-physician group office now boasts two CoaguChek units, and all patients on warfarin are required to be tested and monitored in the office. Each machine cost the group less than $1,000.
“The test results are obtained quickly, the physician adjusts the dose as appropriate, and we schedule the next appointment before [the patients] leave the office,” Dr. Hirsch said. The test is simple to conduct, patients like getting instant results, and the potential complications from warfarin are minimized.
Outsourcing prothrombin time tests was risking both legal liability and patient health. “When blood test results are delayed, even 1 day, and the result is abnormal, during that delay the patient may be taking more doses of warfarin when in fact the medication should have been stopped immediately,” he noted.
In-house testing requires nurse intervention and counseling, so the practice can bill for a nurse visit, the finger stick, and the CoaguChek test. “I would recommend in-house monitoring for any office seeing patients who are taking warfarin,” he said.
If you're frustrated when patients on warfarin fail to get their prothrombin times checked on schedule, Dr. Ronald Hirsch recommends that you do your own patient monitoring, in house.
One patient with a prosthetic mitral valve “was supposed to get his prothrombin checked monthly at the hospital lab. When he came into the office after a 6-month absence with no intervening tests, I realized that it was time to bring prothrombin time testing into our office,” said Dr. Hirsch, an internist in Elgin, Ill.
Dr. Hirsch contacted a Roche Diagnostics representative and saw a demonstration of the CoaguChek device. “We ordered a machine, set up a protocol for testing and quality control, and developed chart templates. Since we were already Clinical Laboratory Improvement Act waived, there was no additional certification needed,” he said in an interview.
The seven-physician group office now boasts two CoaguChek units, and all patients on warfarin are required to be tested and monitored in the office. Each machine cost the group less than $1,000.
“The test results are obtained quickly, the physician adjusts the dose as appropriate, and we schedule the next appointment before [the patients] leave the office,” Dr. Hirsch said. The test is simple to conduct, patients like getting instant results, and the potential complications from warfarin are minimized.
Outsourcing prothrombin time tests was risking both legal liability and patient health. “When blood test results are delayed, even 1 day, and the result is abnormal, during that delay the patient may be taking more doses of warfarin when in fact the medication should have been stopped immediately,” he noted.
In-house testing requires nurse intervention and counseling, so the practice can bill for a nurse visit, the finger stick, and the CoaguChek test. “I would recommend in-house monitoring for any office seeing patients who are taking warfarin,” he said.
If you're frustrated when patients on warfarin fail to get their prothrombin times checked on schedule, Dr. Ronald Hirsch recommends that you do your own patient monitoring, in house.
One patient with a prosthetic mitral valve “was supposed to get his prothrombin checked monthly at the hospital lab. When he came into the office after a 6-month absence with no intervening tests, I realized that it was time to bring prothrombin time testing into our office,” said Dr. Hirsch, an internist in Elgin, Ill.
Dr. Hirsch contacted a Roche Diagnostics representative and saw a demonstration of the CoaguChek device. “We ordered a machine, set up a protocol for testing and quality control, and developed chart templates. Since we were already Clinical Laboratory Improvement Act waived, there was no additional certification needed,” he said in an interview.
The seven-physician group office now boasts two CoaguChek units, and all patients on warfarin are required to be tested and monitored in the office. Each machine cost the group less than $1,000.
“The test results are obtained quickly, the physician adjusts the dose as appropriate, and we schedule the next appointment before [the patients] leave the office,” Dr. Hirsch said. The test is simple to conduct, patients like getting instant results, and the potential complications from warfarin are minimized.
Outsourcing prothrombin time tests was risking both legal liability and patient health. “When blood test results are delayed, even 1 day, and the result is abnormal, during that delay the patient may be taking more doses of warfarin when in fact the medication should have been stopped immediately,” he noted.
In-house testing requires nurse intervention and counseling, so the practice can bill for a nurse visit, the finger stick, and the CoaguChek test. “I would recommend in-house monitoring for any office seeing patients who are taking warfarin,” he said.