Early Point-of-Care Testing at Triage Reduces Care Time in Stable Adult Emergency Department Patients

Singer, Adam J.; Taylor, Merry; LeBlanc, Deborah; Meyers, Kristen; Perez, Karol; Thode, Henry C.; Pines, Jesse M.

doi:10.1016/j.jemermed.2018.04.061

Cited by 37 publications

(30 citation statements)

References 14 publications

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“…Previous studies have found that focused diagnostic tests, such as chest radiography, urine testing, and electrocardiography, at triage shorten ED length of stay 9–15 . Moreover, a drive‐through influenza examination model and a dedicated influenza clinic were also reported to shorten ED length of stay 4,21 .…”

Section: Discussionmentioning

confidence: 99%

“…Although some evidence suggests that performing rapid influenza diagnostic tests in the ED shortens length of stay, 3–7 1 report found that rapid influenza diagnostic tests did not significantly shorten ED length of stay 8 . Furthermore, it has been reported that radiography, electrocardiography, and laboratory investigations performed at triage do shorten ED length of stay 9–15 . To our knowledge, no reports have shown that performing rapid influenza diagnostic tests at triage shortens ED length of stay.…”

Section: Introductionmentioning

confidence: 98%

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Rapid influenza diagnostic test at triage can decrease emergency department length of stay

et al. 2020

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Objective Even if performing rapid influenza diagnostic tests test will not change clinical decision making, we sometimes perform at triage to reduce length of stay in Japan. Whether performing rapid influenza diagnostic tests at triage may shorten emergency department (ED) length of stay (LOS) is remains unclear. We aimed to determine the utility of rapid influenza diagnostic tests at triage in shortening ED length of stay LOS. Methods We retrospectively reviewed medical records of patients discharged from our ED after receiving results from rapid influenza diagnostic tests during the influenza season from December, 2013 to March, 2019. Eligibility criteria were a walk‐in visit, age ≥15 years, triage performed, rapid influenza diagnostic test administered, and no admission. The triage group received rapid influenza diagnostic tests at triage. The after‐examination group received their tests only after examination by a doctor. The primary outcome was ED LOS after propensity score matching to adjust for several covariates. Results Of 2,768 eligible patients, 2,554 patients were enrolled in the triage group (n = 363) or after examination group (n = 2,191). There were 329 matched pairs after propensity score matching. Median ED LOS was significantly shorter in the triage group than in the after‐examination group after propensity score matching (81 min (interquartile range [IQR] 60 to 111) vs 106 min (IQR 80–142); median difference 24 min (95% confidence interval 17–30)). Conclusions Performing rapid influenza diagnostic tests at triage was associated with shorter ED LOS during the influenza season.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Rapid influenza diagnostic test at triage can decrease emergency department length of stay

et al. 2020

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“…Test accuracy has been confirmed when compared with published laboratory standards. [14][15][16][17][18] Although previous studies have suggested that POC testing can reduce ED length of stay (LOS), 13,[19][20][21] to our knowledge, no published literature has examined if POC testing can rapidly exclude DKA with the goal of limiting interventions.…”

Section: Management the 2014 International Society For Pediatric Andmentioning

confidence: 99%

Improving Emergency Department Management of Diabetic Ketoacidosis in Children

et al. 2019

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BACKGROUND: Diagnostic delays in the pediatric emergency department (ED) can lead to unnecessary interventions and prolonged ED length of stay (LOS), especially in patients with diabetes mellitus evaluated for diabetic ketoacidosis (DKA). At our institution, baseline DKA determination time (arrival to diagnosis) was 86 minutes, and 61% of patients did not meet DKA criteria. Subsequently, intravenous (IV) placement occurred in 85% of patients without DKA. We aimed to use point-of-care (POC) testing to reduce DKA determination time from 86 to 30 minutes and to reduce IV placements in patients without DKA from 85% to 20% over 18 months. METHODS: Four key interventions (POC tests, order panels, provider guidelines, and nursing guidelines) were tested by using plan-do-study-act cycles. DKA determination time was our primary outcome, and secondary outcomes included the percentage of patients receiving IV placement and ED LOS. Process measures included the rate of use of POC testing and order panels. All measures were analyzed on statistical process control charts. RESULTS: Between January 2015 and July 2018, 783 patients with diabetes mellitus were evaluated for DKA. After all 4 interventions, DKA determination time decreased from 86 to 26 minutes (P , .001). In patients without DKA, IV placement decreased from 85% to 36% (P , .001). ED LOS decreased from 206 to 186 minutes (P = .009) in patients discharged from the hospital after DKA evaluation. POC testing and order panel use increased from 0% to 98% and 90%, respectively. CONCLUSIONS: Using quality-improvement methodology, we achieved a meaningful reduction in DKA determination time, the percentage of IV placements, and ED LOS.

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“…Laboratory models require blood testing and can therefore cause a substantial delay if blood samples are analysed by a central laboratory. However, these delays might be prevented by point-of-care testing (POCT), which yields results within minutes [16,17].…”

Section: Introductionmentioning

confidence: 99%

Predicting 30-day mortality using point-of-care testing; an external validation and derivation study

et al. 2020

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Background Early risk stratification for guiding treatment priority in the emergency department (ED) is becoming increasingly important. Existing prediction models typically use demographics, vital signs and laboratory parameters. Laboratory-based models require blood testing, which may cause substantial delay. However, these delays can be prevented by the use of point-of-care testing (POCT), where results are readily available. We aimed to externally validate a laboratory-based model for mortality and subsequently assessed whether a POCT model yields comparable performance. Methods All adult patients visiting the ED of a university hospital between January 1 st , 2012 and December 31 st , 2016 were retrospectively reviewed for inclusion. Primary outcome was defined as 30-day mortality after ED presentation. We externally validated one existing prediction model including age, glucose, urea, sodium, haemoglobin, platelet count and white blood cell count. We assessed the predictive performance by discrimination, expressed as Area under the Curve (AUC). We compared the existing model to an equivalent model using predictors that are available with POCT (i.e. glucose, urea, sodium and haemoglobin). Additionally, we internally validated these models with bootstrapping. Results We included 34,437 patients of whom 1,942 (5.6%) died within 30 days. The AUC of the laboratory-based model was 0.794. We refitted this model to our ED population and found an AUC of 0.812, which decreased only slightly to 0.790 with only POCT parameters. Conclusions Our POCT-model performs similar to existing laboratory-based models in identifying patients at high risk for mortality, with results available within minutes. Although the model

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Early Point-of-Care Testing at Triage Reduces Care Time in Stable Adult Emergency Department Patients

Cited by 37 publications

References 14 publications

Rapid influenza diagnostic test at triage can decrease emergency department length of stay

Rapid influenza diagnostic test at triage can decrease emergency department length of stay

Improving Emergency Department Management of Diabetic Ketoacidosis in Children

Predicting 30-day mortality using point-of-care testing; an external validation and derivation study

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