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Do Point-of-Care Tests Fix Overcrowding?

August 10, 2020

Written by Clay Smith

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Emergency department length of stay (LOS) was no different with point-of-care (POC) lab testing in the ED vs central lab processing, despite a significant drop in lab turnaround time (51 minutes faster with POC).

Why does this matter?
We are all looking for solutions to crowding. One point of delay is lab turnaround time. If we get labs back faster, would this reduce LOS?

C-3POC – not the droids we’re looking for?
This was a cluster-randomized trial called – Service d’Urgence Point of Care (SUPOC) – at a single ED in which 7,905 patients had labs drawn. About half had central lab processing, and on alternate weeks, labs were run in the ED with POC tests. POC test offerings were broad: CBC, CMP, troponin, CRP, D-dimer, even procalcitonin. Even though labs came back 51 minutes faster with POC (28 min) vs central lab (79 min), LOS was just 7 min faster for POC (203 min) vs central lab (210 min). This difference in LOS was not statistically significant. This suggests there are other factors contributing to LOS in the ED, such as radiology, nursing staff, consultants, and…well… us. If we don’t follow up the lab results promptly, it doesn’t matter if turnaround time improves. Interestingly, despite very little real improvement in LOS, both patient and clinician satisfaction was higher with use of POC testing. This was single-center, and only 36% of patients had labs drawn. A center with heavier lab utilization might see different results with POC testing.

Impact of point of care testing on length of stay of patients in the emergency department: a cluster randomized controlled study. Acad Emerg Med. 2020 Jul 3. doi: 10.1111/acem.14072. [Epub ahead of print]

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