Point-of-Care Testing Coordinator Recognized by National Publication

For many, “the lab” at Benefis Health System is a place — or a handful of places—where patients go to have their blood drawn. It is also often thought of as the room filled with equipment where clinical laboratory scientists process those blood samples (and many other samples) as we work toward our collective goal of providing excellent patient care.

However, diagnostic information is not confined to the laboratory spaces across our Benefis locations. Some situations require testing in the operating room, other parts of the hospital, or even less conventional places when the patient (or their sample) cannot come to the lab and the lab must come to them. This is point-of-care testing.

At Benefis, Max Mauch is the face of and force behind the Point-of-Care (POC) Testing Program. He is the program’s coordinator and a point-of-care specialist certified by the Association for Diagnostics and Laboratory Medicine, a board-certified medical laboratory scientist with the American Society for Clinical Pathology, and he is also licensed by the Montana Board of Clinical Laboratory Science Practitioners as a clinical laboratory scientist.

“When it comes to point-of-care testing, the real need is to have immediate results,” Max says. “There are situations when you don’t have time to wait on the transport of the sample and analyzer time.”

Currently, the POC Testing Program at Benefis consists of 24 test systems at over 60 locations carried out by over 1,400 test operators. 

This year, Max was recognized by the Medical Laboratory Observer (MLO) magazine for his expertise in the field of POC testing. MLO included Max in its 55 Under 55 list. He was one of only four point-of-care coordinators nationally recognized and the only honoree from Montana.

Max was selected for the list because of his work coordinating POC testing at Benefis, including the heparin assay used in the operating room, the i-STAT device utilized by the Mercy Flight team, and whole blood glucose testing. Max also established a medical laboratory scientist student POC rotation about eight years ago, offering students the opportunity to witness POC testing firsthand and establish a better connection between samples analyzed in the lab and the real-life patients they come from.

Heparin Assay in the Cardiovascular Operating Room

This test system is used to determine the heparin dose for patients undergoing cardiac surgeries that require a bypass and to calculate the protamine dose required for reversing the effects of heparin. During open heart surgery, a perfusionist completes the tests and provides immediate results to the surgical team.

“With coagulation tests, the timing is a big issue,” says Wells Giles, a perfusionist with CVOR Perfusion Group who provides testing during surgeries at Benefis. “The longer you wait, the faster the blood clots, so you need to run the test quickly. There is a time limit on these types of tests.”

i-STAT Used by the Mercy Flight Team

The i-STAT system is a mobile analyzer that measures blood gas and blood chemistry and performs other hematology functions in the field. This device provides diagnostic information that helps the team make quick medical decisions to help triage and stabilize patients before and during transport.

“These guys can be anywhere,” Max says. “They could be in the wilderness or in a rural area that doesn’t have any lab equipment nearby for hours. And they need to have quick results for quick decisions on triaging patients and getting a stabilization plan in place. That’s where this technology comes into play. They can get results within a matter of minutes in the palm of their hand.”

The i-STAT’s small size is also vital to the mission of providing critical care via helicopter. Although the new Mercy Flight helicopter is larger than the previous model, space is at a premium onboard.

“One of the most common uses we have for this is when someone is in respiratory distress. We use it to gather a quick blood gas and figure out how far down the metabolic hole they may be in,” explains Shannon Garner, operations specialist and flight RN with Mercy Flight. “We can make readily discernable decisions in just a matter of two minutes to analyze.”

Mercy Flight can have a patient in their care for an hour or two during triage and transport, and testing with the i-STAT can be repeated to help the crew maintain and even improve a patient’s condition on the way to the hospital. The i-STAT can be used to track blood loss during a call, so the care team knows how much to replace, or measure potassium levels of a patient with kidney issues so care can begin immediately.

“There are many uses for a tool like this,” Shannon says. 

Whole Blood Glucose Testing

Whole blood glucose testing is used in the Emergency Department, inpatient units like the Medical Unit and the ICU, Wound Care, and everywhere in between. This test system is the most widely used POC system at Benefis, and it helps our staff keep patients in glycemic control.

Medical Laboratory Scientist Student Point of Care Rotation

Daniel Enseleit is a clinical laboratory scientist at Benefis. He also completed the POC rotation at Benefis for students. Dan and 18 other students in his cohort were invited to observe an open-heart surgery to see the heparin assay in action, tour the Mercy Flight helicopter and jet to learn about the use of i-STAT in the field, and experience various POC testing applications in wound care, respiratory therapy, and other locations across the system.

The clinical opportunity allows students to see, in real time, how POC testing is used, how the care team interprets the results, and how those results guide changes in patient treatment.

“Max really went out of his way to get us the opportunities to see POC testing happen,” Dan says. “He wants us to learn more about what happens outside the lab.”

Dan recalls how his eyes were opened during a rotation with the respiratory therapy team when he witnessed them insert a chest tube when a patient required intubation.

“The entire experience gave me a lot of empathy for nurses, CNAs, and members of the care team,” he says. “I learned what they deal with and what their workload is as they collect the samples that are sent to the lab. Prior to my POC rotation, the only patient contact I had was two weeks of phlebotomy experience.”

The opportunities, experiences, and firsthand look at workplace culture during his POC rotation prompted Dan to apply for his job at Benefis.

For Max, the takeaway for students is the same thing that keeps him pushing the POC testing program forward — the patients.

“Every single sample is tied to a human being.”