Point-of-care testing speeds patients through ED

By Eleanor McDermid, Senior medwireNews Reporter

Using point-of-care testing, instead of sending samples to a central laboratory, reduces the length of time that patients stay in the emergency department (ED), shows a randomized trial.

But in an editorial accompanying the study in the Annals of Emergency Medicine, Steve Goodacre (University of Sheffield, UK) stresses that this reduced turnaround time will not necessarily relieve overcrowding in the ED.

For example, he says that "point-of-care testing, by reducing turnaround times, reduces the inconvenience of testing and may increase test ordering. If this happens, then length of stay may be prolonged for patients who would otherwise have been managed without blood tests and crowding will persist."

Indeed, the researchers found that the 46-minute reduction in the median time to obtain test results with point-of-care versus central laboratory testing resulted in just a 22-minute reduction in patients' median length of stay, although this was statistically significant.

Sang Do Shin (Seoul National University College of Medicine, Korea) and colleagues studied 10,244 patients aged at least 15 years who were not critically ill but required comprehensive metabolic testing.

The median testing turnaround time - that between drawing of blood and receipt of results - was 21 minutes with point-of-care testing versus 67 minutes for central laboratory testing. The corresponding median lengths of stay were 350 and 372 minutes, which was a significant difference.

Point-of-care testing resulted in significantly shorter stays for patients who were discharged, by a median of 12 minutes, but not for those who were admitted or transferred. It shortened stays by a median of 22 minutes in patients with an Emergency Severity Index (ESI) triage level of 3, but did not affect length of stay in those with a level of 2, 4, or 5.

Goodacre says that a cluster randomization trial - with randomization of time periods or hospitals rather than individual patients - will now be needed to determine whether the intervention can reduce ED overcrowding.

He explains that, although individual patient randomization is essential to obtain accurate estimates of the time saved with point-of-care testing, cluster randomization is needed to test its effect on overall ED operation and economic indices.

"The key point is that the method of randomization used in a trial determines the conclusions that can be drawn," he concludes.

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