POINT-OF-CARE VERSUS CENTRAL LABORATORY TESTING - AN ECONOMIC-ANALYSIS IN AN ACADEMIC-MEDICAL-CENTER

A cost-effectiveness study was conducted to determine time and labor c osts for point-of-care (POC) versus central laboratory testing. A pros pective, observational time and motion study was carried out at a teac hing hospital located in Philadelphia, Pennsylvania. The cohort consis ted of 210 patients presenting to the emergency department who were tr iaged at the urgent or emergent level during a 4-week period. Patients who had blood drawn for a seven-chemistry profile (Chem-7), which inc ludes analysis of sodium, potassium, chloride, carbon dioxide, blood u rea nitrogen, glucose, and creatinine, or for cell blood count (CBC) t ests as part of regular care, also had an additional split sample draw n for POC analysis of sodium, potassium, chloride, blood urea nitrogen , glucose, and/or hematocrit. Blood drawn for POC analysis did not req uire additional needlestick(s), nor did it alter regular care procedur es. Physicians and all emergency department staff participating in the care of the patients were blinded to POC test results. Main outcome m easures included test turnaround time (TAT), physician determination o f impact of rapid TAT and laboratory values on therapeutic approach, a nd cost per test for POC versus central laboratory testing. POC TAT wa s a mean of 8 minutes (time from blood drawn to results shown on the P OC device display). Central laboratory TAT was a mean of 59 minutes (t ime from blood drawn to entry of results into mainframe computer). The rapeutic TAT was a mean of 1 hour and 25 minutes (time from blood draw n to analysis in central laboratory, to when the physician viewed test results). After therapeutic course of care was decided for the patien t, physicians reported that POC testing, independent of other rate-lim iting steps, would have resulted in earlier therapeutic action for 40 of 210 (19.0%) patients. The cost per test for Chem-7 and CBC tests wa s $11.14 and $9.48, respectively. The cost per test for POC analysis r anged from $14.37 to $16.67, depending on the POC test volume (estimat ed volume based on 20% to 50% of emergency department patients that ha d either Chem-7 or CBC test done applied over the useful life of the P OC testing equipment) and the personnel (nurse or emergency department technician) who performed the test. With an increasing volume of POC tests performed per unit time, costs for POC testing would be reduced substantially. POC test costs are volume dependent under current reimb ursement mechanisms for emergency department patient care services, fo r example, free-for-service payment. Costs for POC tests versus compar able central laboratory assays do not account for emergency department throughput efficiency benefits, such as faster TAT and shortened leng th of stay. From a clinical management perspective, patient consumer i ssues such as expectations for timely and efficient health services de livery and earlier physician decisions on course of care suggest that selective use of POC testing in the emergency department can result in long-standing cost savings to the hospital.