Point-of-care testing speeds emergency care

When compared with conventional central laboratory testing (CLT), point-of-care testing (POCT) in the emergency department shortens the time taken for patient test results to be available, which in turn leads to speedier clinical decisions and much earlier patient treatment, hospital admission or discharge. 

These are the headline findings of a recently published randomized controlled trial conducted at the emergency departments of five teaching hospitals in South Korea. For this study 2323 patients admitted to emergency department and requiring blood chemistry testing were randomly assigned to either POCT (n=1167) or CLT (n=1156). 

The principal outcome measure was door-to-clinical-decision (D2D) time, defined as the time from patient registration to making clinical decision after consideration of test results. In addition, the turnaround time (TAT) defined as the time from sample collection to receipt of test result(s) was measured for each patient. 

The median TAT for the POCT group was just 14 minutes (interquartile [IQ] range 12-19 minutes), significantly shorter than the median TAT of 55 minutes (IQ range 45-69 minutes) among those assigned to have their testing performed in the central laboratory. Test results prompted new clinical decision of one sort or another in 67.9 % of patients in the POCT group and 68.1 % of patients in the CLT group. 

The median D2D time for those in the POCT group was 46 minutes (IQ range 33-61 minutes); considerably shorter than that for the CLT group, which was 86 minutes (IQ range 68-107 minutes). Clinical decisions were made in less than an hour for 72.8 % of patients in the POCT group, but only for 12.5 % of patients in the CLT group. 

The paper provides more objective evidence of the widely held intuition that point-of-care testing increases the speed of care and disposition of patients in emergency departments.