Core laboratory testing may increase length of stay and delay care.
We compared length of emergency department (ED) care in patients receiving point-of-care
testing (POCT) at triage vs. traditional core laboratory testing.
We conducted a prospective, case-controlled trial of adult patients with prespecified
conditions requiring laboratory testing and had POCT performed by a nurse after triage
for: a basic metabolic panel, troponin I, lactate, INR (i-STAT System), urinalysis
(Beckman Coulter Icon), or urine pregnancy test. Study patients were matched with
controls based on clinical condition, gender, age, and time to be seen. Groups were
compared with Wilcoxon rank–sum or Fisher's exact tests.
We matched 52 POCT study patients with 52 controls. Groups were similar in age, gender,
clinical condition, time to be seen by a physician (3.3 h, 95% confidence interval
[CI] 2.2–4.4, vs. 3.1 h, 95% CI 2.2–4.5 h, in POCT and control patients, respectively;
p = 0.84), use of imaging, and disposition. Of 52 study patients, 3 (5.8%, 95% CI 2.0–15.9)
were immediately transferred to the critical care area to be urgently seen by an emergency
physician. POCT patients had a significantly shorter median (interquartile range [IQR])
ED care time than matched controls (7.6, 95% CI 5.1–9.5 vs. 8.5, 6.2–11.3 h, respectively;
p = 0.015). Median [IQR] ED length of stay was similar in study patients and controls
(9.6, 95% CI 7.9–14.5 vs. 12.5, 8.2–21.2 h, respectively; p = 0.15).
Among stable adult patients presenting to the ED with one of the prespecified conditions,
early POCT at triage, compared with traditional core laboratory testing after evaluation
by an ED provider, reduced ED care time by approximately 1 h.