Clinical outcomes of point-of-care testing in the interventional radiologyand invasive cardiology setting

Background: Point-of-care testing (POCT) can provide rapid test results, bu t its impact on patient care is not well documented. We investigated the ab ility of POCT to decrease inpatient and outpatient waiting times for cardio vascular procedures. Methods: We prospectively studied, over a 7-month period, 216 patients requ iring diagnostic laboratory testing for coagulation (prothrombin time/activ ated partial thromboplastin time) and/or renal function (urea nitrogen, cre atinine, sodium, and potassium) before elective invasive cardiac and radiol ogic procedures. Overall patient management and workflow were examined in t he initial phase. In phase 2, we implemented POCT but utilized central labo ratory results for patient management. In phase 3, therapeutic decisions we re based on POCT results. The final phase, phase 4, sought to optimize work flow around the availability of POCT. Patient wait and timing of phlebotomy , availability of laboratory results, and therapeutic action were monitored . Split sampling allowed comparability of POCT and central laboratory resul ts throughout the study. Results: In phase 1, 44% of central laboratory results were not available b efore the scheduled time for procedure (n = 135). Mean waiting times (arriv al to procedure) were 188 +/- 54 min for patients who needed renal testing (phase 2; n = 14) and 171 +/- 76 min for those needing coagulation testing (n = 24). For patients needing renal testing, POCT decreased patient wait t imes (phases 3 and 4 combined, 141 +/- 52 min; n = 18; P = 0.02). For patie nts needing coagulation testing, wait times improved only when systematic c hanges were made in workflow (phase 4, 109 +/- 41 min; n = 12; P = 0.01). Conclusions: Although POCT has the potential to provide beneficial patient outcomes, merely moving testing from a central laboratory to the medical un it does not guarantee improved outcomes. Systematic changes in patient mana gement may be required. (C) 2000 American Association for Clinical Chemistr y.