patients can be reduced when blood tests are processed using point-of-care(POC) devices; to conduct a cost-effectiveness analysis of POC compared to laboratory testing. Methods:This randomised trial enrolled adults suspected of an acute coronary syndrome(ACS) or presenting with conditions considered to only require blood tests available by POC. Participants were randomised to have blood tests processed by POC or laboratory. Outcomes measured were time to disposition decision and ED length-ofstay(LOS). The cost-effectiveness analysis calculated total and mean costs per ED presentation, as well as total and mean benefits in time saved to disposition decision.Results: There were 410 POC participants and 401 controls. The mean times to a disposition decision for POC versus controls was 3.24 hours and 3.50 hours respectively, a difference of 7.6%(95%CI 0.4%-14.3%, p=0.04) and 4.32 and 4.52 hours respectively for EDLOS, a difference of 4.4%(95%CI -2.7%-11.0%, p=0.21). Improved processing time was greatest for participants enrolled by senior staff with a reduction in time to disposition decision of 19.1%(95%CI 7.3%-29.4%, p<0.01) and EDLOS of 15.6%(95%CI 4.9%-25.2%, p=0.01).Mean pathology costs were $12 higher in the POC group (95%CI $7-18) and the incremental cost-effectiveness ratio was $113 per hour saved in time to disposition decision for POC compared to standard laboratory testing. Conclusions:Small improvements in disposition decision time were achieved with POC testing, for a moderate increase in cost. Greatest benefit may be achieved when POC is targeted to senior medical staff.

Objective : Australian EDs are required to conform to the National Emergency Access Target (NEAT): patients must be discharged within 4 h of arrival. The aim of the present study was to determine if a model of care called Senior Assessment and Streaming (SAS) would increase the proportion of patients achieving NEAT. Methods:Stable, ambulant patients considered to have problems that early consultant-level assessment was likely to improve processing efficiency were streamed through a dedicated clinical area staffed by an ED physician, intern and nurse. The proportion of patients achieving NEAT were compared between days with or without SAS, adjusted for confounding variables. Results:The 18 962 patients presented during the study, 6828 on days with SAS, 12 134 on days without. On days with SAS, there were more presentations, more admissions, lower access to ward beds and fewer staff working hours. After controlling for confounding, the odds of meeting NEAT on days with SAS was 15% higher compared with days without (odds ratio, 1.15; 95% confidence interval [CI], 1.07-1.24; P < 0.001). For the subgroups of patients admitted, discharged, triage category 3, 4, 5, or presentation 12.00-18.00 the odds of meeting NEAT on days with SAS was, respectively, 1.10 (95% CI, 0.98-1.23; P = 0.10), 1.17 (95% CI, 1.07-1.28; P < 0.001), 1.17 (95% CI, 1.08-1.27; P < 0.001) and 1.19 (95% CI, 1.06-1.35; P = 0.003). The odds of a patient not waiting to be seen on days with SAS was 28% lower compared with days without (odds ratio, 0.72; 95% CI, 0.58-0.90; P = 0.003). Conclusion:Through the introduction of SAS, the present study has demonstrated that providing early senior medical assessment can improve an ED's ability to meet NEAT.

NEAT targets were improved in the ED of a tertiary referral hospital after the introduction of the EJC role.

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