Point-of-care testing reduces length of stay in emergency department chest pain patients
ABSTRACT We determine the effect of cardiac troponin I point-of-care testing on emergency department (ED) length of stay in chest pain patients.
This was a before-and-after trial in a university-based ED with 75,000 annual visits. Participants were consecutive patients with a chief complaint of chest pain who were admitted to the hospital. During the first 2-week period (before), only central laboratory testing of troponin was performed. During the second 2-week period (after), treating nurses performed bedside point-of-care testing for troponin I, as well as central laboratory testing. Test turnaround times, time from triage until calling in admissions, and time from triage until patients left the ED to be transferred to a floor (ED length of stay) were determined and compared between the 2 study periods. Comparisons between study periods are expressed as mean differences with 95% confidence intervals (CIs). A sample of 100 patients in each group had 90% power to detect a 1-hour difference in length of stay (2-tailed alpha=0.05).
There were 232 patients before and 134 after introduction of point-of-care testing. Mean age (SD) was 63 years (16 years), and 44% were female patients. Baseline characteristics were similar in both groups. The rate of positive troponins was also similar (9.5% versus 6.1%). ED length of stay was significantly reduced after introduction of point-of-care testing (5.2 hours [95% CI 4.6 to 5.8 hours] versus 7.1 hours [95% CI 6.6 to 7.7 hours]; mean difference 1.9 hours [95% CI 1.1 to 2.7 hours]). The time until the admission was called in to bed control was also significantly reduced by introducing point-of-care testing (2.7 hours [95% CI 2.4 to 3.1 hours] versus 4.7 hours [95% CI 4.3 to 5.0 hours]; mean difference 1.9 hours [95% CI 1.4 to 2.5 hours]). Point-of-care testing turnaround (14.8 minutes [95% CI 14.1 to 15.5 minutes]) was significantly shorter than for central laboratory testing (83 minutes [95% CI 77 to 89 minutes]; mean difference 68 minutes [95% CI 62 minutes to 74 minutes]). With central testing as the criterion standard, point-of-care testing had a sensitivity of 100% (95% CI 63% to 100%) and a specificity of 96% (95% CI 92% to 99%).
Bedside performance of troponin I point-of-care testing by treating nurses significantly reduces ED length of stay.
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ABSTRACT: Intra-laboratory turnaround time (TAT) is a key indicator of laboratory performance. Improving TAT is a complex task requiring staff education, equipment acquisition, and adequate TAT monitoring. The aim of the present study was to evaluate the intra-laboratory TAT after laboratory automation implementation (June 2013-June 2014) and to compare it to that in the preautomation period (July 2012-May 2013). Intra-laboratory TAT was evaluated both as the mean TAT registered and the percentage of outlier (OP) exams. The mean TAT was 36, 38, and 34 min during the study periods, respectively. These values respected the goal TAT established at 45 min. The OP, calculated at 45 min as well as at 60 min, decreased from 26 to 21 and from 11 to 5, respectively. From a focused analysis on blood count cell, troponin I, and prothrombin (PT) test, TAT improvement was more evident for tests requiring longer preanalytical process. The follow-up of TAT from June 2013 to June 2014 revealed the reduction of the mean TAT as well as of the OP exams after automation implementation and that automation more strongly affects the test in the preanalytical phase including centrifugation of the sample, such as troponin I and PT. © 2015 Society for Laboratory Automation and Screening.Journal of the Association for Laboratory Automation 01/2015; DOI:10.1177/2211068214566458 · 1.50 Impact Factor
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ABSTRACT: Emergency departments (EDs) face several challenges in maintaining consistent quality care in the face of steadily increasing public demand. Improvements in the survival rate of critically ill patients in the ED are directly related to the advancement of early recognition and treatment. Frequent episodes of overcrowding and prolonged waiting times force EDs to operate beyond their capacity and threaten to impact upon patient care. The objectives of this review are as follows: (a) to establish overcrowding as a threat to patient outcomes, person-centered care, and public safety in the ED; (b) to describe scenarios in which point-of-care testing (POCT) has been found to ameliorate factors thought to contribute to overcrowding; and (c) to discuss how POCT can be used directly, and indirectly, to expedite patient care and improve outcomes. Various studies have shown that overcrowding in the ED has profound effects on operational efficiency and patient care. Several reports have quantified overcrowding in the ED and have described a relationship between heightened periods of overcrowding and delays in treatment, increased incidence of adverse events, and an even greater probability of mortality. In certain scenarios, POCT has been found to increase the number of patients discharged in a timely manner, expedite triage of urgent but non-emergency patients, and decrease delays to treatment initiation. This review concludes that POCT, when used effectively, may alleviate the negative impacts of overcrowding on the safety, effectiveness, and person-centeredness of care in the ED.Critical Care 12/2014; 18(6). DOI:10.1186/s13054-014-0692-9 · 5.04 Impact Factor
American Journal of Emergency Medicine 12/2014; DOI:10.1016/j.ajem.2014.12.018 · 1.15 Impact Factor