Impact of Point‐of‐care Testing on Length of Stay of Patients in the Emergency Department: A Cluster‐randomized Controlled Study

Abstract

Objectives: Crowding is a frequent concern in the emergency department (ED). Laboratory point-of-care testing (POCT) has been proposed to decrease patients' length of stay (LOS). Our objective was to determine whether an extended panel of POCT solutions could reduce LOS. Methods: This was a single-center, prospective, open-label, controlled cluster-randomized study. Blood test processing was randomized into 1-week inclusion periods: interventional arm (laboratory analyses performed on POCT analyzers implemented in the ED) or control arm (central laboratory). The primary endpoint was LOS of patients in the ED. Secondary endpoints were time to result (TTR), ED crowding surrogates, and average total cost of an ED visit in each arm. Results: A total of 23,231 patients were included and 20,923 were analyzed for the main outcome measure. Mean AE SD age was 46 AE 20 years, and 7,905 (36%) underwent blood sampling. Mean AE SD LOSs were 203 AE 161 and 210 AE 168 minutes in the POCT and control arms, respectively. LOS reduction for the entire ED population was À9 minutes (95% confidence interval [CI] = À22 to 5, p = 0.22) compared to the control arm and À17 minutes (95% CI = À34.0 to 0.6, p = 0.06) for patients undergoing blood sampling. The mean AE SD TTRs were 28 AE 31 and 79 AE 34 minutes in the POCT and control arms, respectively (TTR reduction = À51 minutes, 95% CI = À54 to À48 minutes, p < 0.001).

The Impact of Prehospital Point of Care Ultrasounds on Emergency Patients Length of Stay in Thailand

“… 31–33 However, these solutions remain controversial and are limited by the small number of studies, especially in terms of the contributions of the POCUS examination. 32 …”

Optimization of Patient Management in the Gynecology Emergency Department Using Point-of-Care Beta hCG

“…All previous studies reported that the introduction of POCT in the ED significantly reduced the delay between the sample acquisition and the test results, but addressing the impact of POCT on flow processing in the ED has given conflicting results [ 6 , 7 ]. In a large prospective cluster-randomized controlled trial involving more than 20,000 patients in the ED, Hausfater et al observed a significant reduction in the time to result (51 min) in the POCT arm (including one hematology analyzer for blood count; two blood gas analyzers with urea and creatinine; one biochemistry analyzer for liver enzymes, bilirubin, lipase and creatine kinase; and two immunoassay analyzers for troponin T, NT-proBNP, C-reactive protein, procalcitonin, hCG and D-dimer), with no impact on the LOS (−9 min) [ 29 ]. In the study conducted by Lewandrowski et al, the implementation of a D-dimer POCT in the ED led to a decrease in the total TAT (from blood draw to the availability of test results) from approximately 2 h to 25 min.…”

“…Rapid TATs are the most beneficial if the test results are the primary determining factor holding up patient management decisions [ 2 , 3 ]. The βhCG measurement is just one part of the patient care, and the time required to obtain βhCG results in the central lab is only one of the bottlenecks contributing to the total LOS [ 2 , 29 ]. Factors such as vital signs, patient severity and factors affecting the examination regimen such as day of the week and time of day will have an effect on TAT.…”

Opportunity Gains Overlooked

“…I n the most recent issue of Academic Emergency Medicine, Hausfater et al 1 describe the impact of pointof-care testing (POCT) on patient throughput, patient and provider satisfaction, and health economics. This well-designed study found a significant reduction in time-to-result (51 minutes), but no statistically significant decrease in overall length of stay (9 minutes).…”

“…When an emergency department (ED) is overcrowded, all treatment spaces are full, many treatment spaces are holding admitted patients, and patients waiting cannot be seen. There are opportunity costs related to unused admissions spaces, such as inpatient units or holding areas, and to underutilized ED treatment spaces, in which new patients could be seen 2‐5 …”