Point of care testing in the emergency department: Finding comprehensive solutions that work for you

Speed and precision are two of the most vital considerations when it comes to patient care in the high-stakes environment of the Emergency Department (ED). Thus, swift decision-making and accurate diagnostics are not just desirable but absolutely essential in this critical environment.

Amidst this urgency, the topic of Point of Care Testing (POC) emerges as a viable solution. This article will delve into the transformative impact of POCT, exploring how it is reshaping the fabric of emergency medical decisions. It will also introduce several innovative solutions that are revolutionizing how patient care is being approached in critical scenarios.

The overcrowding crisis

Since the early 2000s, overcrowded EDs have become an escalating global concern,¹ in some countries even being recognized as a national crisis.²

Such overcrowding correlates with increased patient mortalities, delay in critical care, longer physician/operation waiting times, misplacement of patients into the incorrect ward, decreased patient safety, reduced availability of inpatient beds, and overall inefficient inpatient flow within EDs.³ This crisis ultimately stems from the huge imbalance between the capacity of EDs and their patient demands.³

The heart of the issue lies in the fact that nearly 70% of patients are funneled into hospitals via the ED.^4,5 Excessively high hospital occupancy rates, often exceeding 90%, and access blocks have been pinpointed as the primary culprits behind unfavorable patient outcomes.

These conditions lead to delayed treatments, escalated mortalities (ranging from 20% to 30%), prolonged inpatient stays, and heightened rates of hospital readmissions.⁶

For example, in patients with acute myocardial infarction, every 30-minute delay has been associated with a relative increase in the risk of 1-year mortality. Specifically, the relative risk increases by 1.075 (95% CI: 1.008 to 1.15; P=0.041).⁷

To alleviate the pressure on EDs, multiple solutions have been explored. One such solution is the implementation of rapid, on-site clinical tests through Point of Care Testing (POCT).³

The need for point-of-care testing

Routine diagnostics traditionally rely on laboratory-based, quantitative sample analysis for various biomarkers/biochemical parameters. The turnaround time for these tests can range from several hours to days.

While many results are obtained more quickly, this delay nonetheless plays a role in exacerbating overcrowding in EDs and hampers the efficiency of patient flow throughout the hospital healthcare system.³

The incorporation of POCT in EDs significantly decreases the turnaround time of test results associated with moving analytical instruments to the ED from laboratories.³ This allows for faster clinical decision-making for quicker treatment administration, as well as faster operational decisions, thus improving patient flow and outcomes in the ED.

In one example, compared to traditional diagnostic services, the POCT system reduced the median time for a patient to be confirmed as ‘ready to leave the ED’ by almost an hour.⁸

Additionally, in certain scenarios, POCT might also be more cost-effective than laboratory diagnoses. However, further research is required to confirm this.⁹ Therefore, POCT has the potential to save time and money, making it a fundamental tool in alleviating the global ED overcrowding crisis.^8,9

Introducing a comprehensive solution for EDs

Atellica VTLi System – An ideal tool for chest pain assessment

Recent advancements have significantly improved the precision of point-of-care (POC) methods for evaluating chest pain, addressing a long-standing limitation compared to laboratory-based assays, which limited the accelerated assessment of patients suspected of acute coronary syndrome (ACS). ¹⁰

The Atellica^® VTLi Patient-side Immunoassay Analyzer offers precise and rapid results that aid in the diagnosis of myocardial infarction, ensuring safe management for patients with suspected ACS.

With high-sensitivity troponin (hs-cTnI) results available on a capillary sample in 8 minutes at the patient's side, clinicians using the Atellica^® VTLi Patient-side Immunoassay Analyzer in the ED can leverage both speed and accuracy when considering a differential diagnosis for patients presenting with chest pain.

This advanced technology empowers healthcare professionals to make crucial decisions in a single physician-patient interaction, providing swift answers to patients and streamlining emergency department operations.

Please note: The products/features (mentioned herein) are not commercially available in all countries. Not available for sale in the US. Their future availability cannot be guaranteed.

Image Credits: Siemens Healthineers

The epoc blood analysis system and RAPIDPoint Blood Gas System

The epoc^® Blood Analysis System provides comprehensive critical care results at the patient's side in less than 1 minute. It can provide a snapshot of a patient's health and highlight problems such as heart rhythm changes, respiratory distress, insulin shock, diabetic coma, sepsis, and kidney failure.

Complementary to this system is the RAPIDPoint 500e analyzer, a sophisticated device that handles sample aspiration, maintenance, quality control, and calibration. This automation reduces the need for specialized training and personnel, ensuring accurate results and minimizing errors. The analyzer is fast, easy to use, and requires minimal maintenance, making it a practical choice.

The combined power of these point-of-care tests has led to significant improvements in EDs. Huntsville Hospital in Alabama, for instance, saw a 50% reduction in sepsis-related mortality, and the QHC Prince Edward County Memorial Hospital in Ontario, Canada, reduced clinical costs by 82% in 2016, demonstrating the practical impact of this diagnostic approach.^{11, 12}

Point of care urinalysis with CLINITEK Status+ Urine Analyzer

Urinalysis is a simple and inexpensive test that can be performed in the ED to evaluate suspected acute and chronic diseases, including urinary tract infections, and screen for pregnancy in people of childbearing age.^{13, 14}

Siemens Healthineers' CLINITEK Status^®+ Analyzer is the only dual-purpose point-of-care analyzer for urinalysis testing and urine hCG pregnancy testing. When used with the CLINITEST^® hCG Cassette assays, the waiting time for test results has been reduced to a mere five minutes.¹⁵

The CLINITEK Status^® + Analyzer and CLINITEK Status^® Connect System both feature an automated result interpretation system, eliminating subjectivity in result analysis. Additionally, automatic recording and transmission of results minimize transcriptional errors.

The integrated barcode scanner streamlines data entry, saving valuable staff time. Moreover, the system includes a user lockout function, ensuring that only trained operators can access and use the equipment.

Presented at Institute for Quality Management in Healthcare ConferenceToronto, Canada, October 2016

Image Credits: Siemens Healthineers

The POCcelerator^® Data Management System

Due to the large volume of patients that enter the ED, POCT requires a robust data management system that can seamlessly integrate into complex POCT workflows while managing thousands of operators – and the POCcelerator^® Data Management System delivers just that. The POCcelerator system connects more than 230 device interfaces across 70+ manufacturers to quickly transmit POCT results.

This data management solution seamlessly connects your entire POCT network through a single interface, ensuring a seamless IT solution. It automates operator training, permissions, and certification management while providing optimal performance of testing devices and efficient transmission of diagnostic results.

The POCcelerator system has demonstrated significant economic benefits, yielding Queensland Health, Australia, a direct economic benefit by an increase of their re-imbursement rate by 5% and saving 8 hours of coordinator time per week¹⁶.

Conclusion

With the evolution of clinical diagnostic assays tailored for point-of-care testing (POCT), emergency departments worldwide are optimizing their utilization of this technology. The integration of rapid and precise clinical testing through POC assays, complemented by other methods, not only shortens patient wait times in EDs but also alleviates the strain on staff.

Siemens Healthineers can offer the abovementioned assays to streamline patient flow in your hospital’s ED. By enhancing patient outcomes and improving both patient and staff experiences, these assays pave the way for more efficient and effective emergency medical care.

Get in contact with a member of the team today to find out more, or visit siemens-healthineers.com/EmergencyDepartment to request a demo of any of the solutions highlighted in this article.

Atellica, CLINITEK Status, CLINTEST, epoc, Integri-sense, POCcelerator, RAPIDPoint, and all other associated marks are trademarks of Siemens Healthcare Diagnostics Inc. or its affiliates. All other trademarks and brands are the property of their respective owners. Product availability may vary from country to country and is subject to varying regulatory requirements. Please contact your local representative for availability. Atellica VTLi System is not available for sale in the US. Future availability cannot be guaranteed.

References and further reading

1. Eitel, D.R., Rudkin, S.E., Malvehy, M.A., Killeen, J.P. and Pines, J.M. 2010. Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine. The Journal of emergency medicine. 38(1), pp.70-79.
2. Institute of Medicine Committee on the Future of Emergency Care in the US Health System. 2006. The future of emergency care in the United States health system. Annals of emergency medicine. 48(2), pp.115-120.
3. Yarmohammadian, M.H., Rezaei, F., Haghshenas, A. and Tavakoli, N. 2017. Overcrowding in emergency departments: a review of strategies to decrease future challenges. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 22.
4. De Sutter, J., De Bacquer, D., Kotseva, K., Sans, S., Pyorala, K., Wood, D., De Backer, G. and EUROASPIRE II study group. 2003. Screening of family members of patients with premature coronary heart disease: results from the EUROASPIRE II family survey. European Heart Journal, 24(3), pp.249-257.
5. Scanlon, P.J., Faxon, D.P., Audet, A.M., Carabello, B., Dehmer, G.J., Eagle, K.A., Legako, R.D., Leon, D.F., Murray, J.A., Nissen, S.E. and Pepine, C.J. 1999. ACC/AHA guidelines for coronary angiography11 “ACC/AHA Guidelines for Coronary Angiography” was approved by the American College of Cardiology Board of Trustees in October 1998 and by the American Heart Association Science Advisory and Coordinating Committee in December 1998.22 When citing this document, the American College of Cardiology and the American Heart Association request that the following format be used: Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, Legako RD, Leon DF .... Journal of the American College of Cardiology. 6(33), pp.1756-1824.
6. Shrivastava, S., Trung, T.Q. and Lee, N.E. 2020. Recent progress, challenges, and prospects of fully integrated mobile and wearable point-of-care testing systems for self-testing. Chemical Society Reviews, 49(6), pp.1812-1866.
7. De Luca, G., Suryapranata, H., Ottervanger, J.P. and Antman, E.M. 2004. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 109(10), pp.1223-1225.
8. Jarvis, P.R.E., Davies, T.M., Mitchell, K., Taylor, I. and Baker, M. 2014. Does rapid assessment shorten the amount of time patients spend in the emergency department?. British Journal of Hospital Medicine. 75(11), pp.648-651.
9. Goldstein, L.N., Wells, M. and Vincent-Lambert, C. 2019. The cost-effectiveness of upfront point-of-care testing in the emergency department: a secondary analysis of a randomised, controlled trial. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27(1), pp.1-12.
10. Collet JP, Thiele H, Barbato E, et al. Eur Heart J. 2021:1289-1367.
11. Agarwal, S., Shafi, R., Edwards, R.M., Collymore, L. and Devaraj, S., 2014. Evaluation of the analytical performance of the modified enterprise point-of-care blood gas and electrolyte analyzer in a pediatric hospital. Point of Care. 13(4), pp.132-136.
12. The QHC Prince Edward Country Memorial Hospital (PECMH) in Pitcon, Ontario. Presented at Institute for Quality Management in Healthcare Conference, Toronto, Canada, October 2016.
13. Dubbs, S.B. and Sommerkamp, S.K. 2019. Evaluation and management of urinary tract infection in the emergency department. Emergency Medicine Clinics. 37(4), pp.707-723.
14. Olshaker, J.S. 1996. Introduction to the new section “Clinical Laboratory in Emergency Medicine” Emergency department pregnancy testing. The Journal of emergency medicine. 14(1), pp.59-65.
15. Siemens Healthineers CLINITEK Status^®+ Analyzer Users Guide: https://cdn0.scrvt.com/39b415fb07de4d9656c7b516d8e2d907/1800000005980302/db3f534418ab/10379675_CLINITEK_Status_Plus_Operators_Manual_Rev_C-2011-12_Eng-US_1800000005980302.pdf
16. Queensland case study. Siemens Healthcare Diagnostics Inc. 2018.

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