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Impact from point-of-care devices on emergency department patient processing times compared with central laboratory testing of blood samples: a randomised controlled trial and cost-effectiveness analysis
  1. Stephen Edward Asha1,2,
  2. Adam Chiu Fat Chan1,2,
  3. Elizabeth Walter1,
  4. Patrick J Kelly3,
  5. Rachael L Morton3,
  6. Allan Ajami1,
  7. Roger Denis Wilson2,4,
  8. Daniel Honneyman1
  1. 1Emergency Department, St George Hospital, Sydney, New South Wales, Australia
  2. 2Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  4. 4South Eastern Area Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia
  1. Correspondence to Dr Stephen Asha, Emergency Department, St George Hospital, Gray St, Kogarah, Sydney, NSW 2217, Australia; stephen.asha{at}sesiahs.health.nsw.gov.au

Abstract

Objective To determine if time to disposition decisions for emergency department (ED) patients can be reduced when blood tests are processed using point-of-care (POC) devices and to conduct a cost-effectiveness analysis of POC compared with laboratory testing.

Methods This randomised trial enrolled adults suspected of an acute coronary syndrome or presenting with conditions considered to only require blood tests available by POC. Participants were randomised to have blood tests processed by POC or laboratory. Outcomes measured were time to disposition decision and ED length-of-stay (LOS). The cost-effectiveness analysis calculated the total and mean costs per ED presentation, as well as total and mean benefits in time saved to disposition decision.

Results There were 410 POC participants and 401 controls. The mean times to a disposition decision for POC versus controls were 3.24 and 3.50 h respectively, a difference of 7.6% (95% CI 0.4% to 14.3%, p=0.04), and 4.32 and 4.52 h respectively for ED LOS, a difference of 4.4% (95% CI −2.7% to 11.0%, p=0.21). Improved processing time was greatest for participants enrolled by senior staff with a reduction in time to disposition decision of 19.1% (95% CI 7.3% to 29.4%, p<0.01) and ED LOS of 15.6% (95% CI 4.9% to 25.2%, p=0.01). Mean pathology costs were $12 higher in the POC group (95% CI $7 to $18) and the incremental cost-effectiveness ratio was $113 per hour saved in time to disposition decision for POC compared with standard laboratory testing.

Conclusions Small improvements in disposition decision time were achieved with POC testing for a moderate increase in cost. Greatest benefit may be achieved when POC is targeted to senior medical staff.

  • cost effectiveness
  • diagnosis
  • emergency care systems, efficiency

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