Early Point-of-Care Testing at Triage Reduces Care Time in Stable Adult Emergency Department Patients



      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.


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        • Pines J.M.
        • Hilton J.A.
        • Weber E.J.
        • et al.
        International perspectives on emergency department crowding.
        Acad Emerg Med. 2011; 18: 1358-1370
        • Bernstein S.L.
        • Aronsky D.
        • Duseja R.
        • et al.
        The effect of emergency department crowding on clinically oriented outcomes.
        Acad Emerg Med. 2009; 16: 1-10
        • Sun B.C.
        • Hsia R.Y.
        • Weiss R.E.
        • et al.
        Effect of emergency department crowding on outcomes of admitted patients.
        Ann Emerg Med. 2013; 61: 605-611.e6
        • Singer A.J.
        • Thode Jr., H.C.
        • Viccellio P.
        • Pines J.M.
        The association between length of emergency department boarding and mortality.
        Acad Emerg Med. 2011; 18: 1324-1329
        • Gaieski D.F.
        • Mikkelsen M.E.
        • Band R.A.
        • et al.
        Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department.
        Crit Care Med. 2010; 38: 1045-1053
        • Cannon C.P.
        • Gibson C.M.
        • Lambrew C.T.
        • et al.
        Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction.
        JAMA. 2000; 283: 2941-2947
        • Pines J.M.
        • Zocchi M.S.
        • Buchanan M.E.
        • Shah M.N.
        • Travers D.
        The utility of point-of-care testing at emergency department triage by nurses in simulated scenarios.
        Adv Emerg Nurs J. 2017; 39: 152-158
        • Pines J.M.
        • Zocchi M.S.
        • Buchanan M.E.
        • et al.
        Creating ED point-of-care testing protocols: an expert panel and Delphi process.
        Am J Emerg Med. 2015; 33: 463-465
        • Soremekun O.A.
        • Datner E.M.
        • Banh S.
        • Becker L.B.
        • Pines J.M.
        Utility of point-of-care testing in ED triage.
        Am J Emerg Med. 2013; 31: 291-296
        • Pines J.M.
        • Griffey R.T.
        What we have learned from a decade of ED crowding research.
        Acad Emerg Med. 2015; 22: 985-987
        • Goyal M.
        • Pines J.M.
        • Drumheller B.C.
        • Gaieski D.F.
        Point-of-care testing at triage decreases time to lactate level in septic patients.
        J Emerg Med. 2010; 38: 578-581
        • Singer A.J.
        • Williams J.
        • Taylor M.
        • Le Blanc D.
        • Thode Jr., H.C.
        Comprehensive bedside point of care testing in critical ED patients: a before and after study.
        Am J Emerg Med. 2015; 33: 776-780
        • Singer A.J.
        • Taylor M.
        • LeBlanc D.
        • Williams J.
        • Thode Jr., H.C.
        ED bedside point-of-care lactate in patients with suspected sepsis is associated with reduced time to iv fluids and mortality.
        Am J Emerg Med. 2014; 32: 1120-1124
        • Jang J.Y.
        • Shin S.D.
        • Lee E.J.
        • Park C.B.
        • Song K.J.
        • Singer A.J.
        Use of a comprehensive metabolic panel point-of-care test to reduce length of stay in the emergency department: a randomized controlled trial.
        Ann Emerg Med. 2013; 61: 145-151