IMPACT OF POINT-OF-CARE TESTING ON PATIENTS LENGTH OF STAY IN A LARGEEMERGENCY DEPARTMENT

We prospectively investigated whether routine use of a point-of-care t esting (POCT) device by nonlaboratory operators in the emergency depar tment (ED) for all patients requiring the available tests could shorte n patient length of stay (LOS) in the ED. ED patient LOS, defined as t he length of time between triage (initial patient interview) and disch arge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POC T device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of t he hand-held device. Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use, Among nearly 15 000 ED patient visits during th e study period, 4985 patients (2067 during the experimental period and 2918 during the two control periods) had at least one Na, K, Cl, BUN, or Gluc test ordered from the ED. However, no decrease in ED LOS was observed in the tested patients during the experimental period. Median LOS during the experimental period was 209 min vs 201 min for the com bined control periods. Stratifying patients by presenting condition (c hest pain, trauma, etc.), discharge/admit status, or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period. From the se observations, we consider it unlikely that routine use of a hand-he ld POCT device in a large ED such as ours is sufficient by itself to i mpact ED patient LOS.