Comprehensive bedside point of care testing in critical ED patients: A before and after study

Objective We determined the effects of comprehensive point-of-care testing (POCT) on process of care in critically ill emergency department (ED) patients. We hypothesized that POCT would shorten ED length of stay (LOS), reduce time to test results, and reduce time to completion of intravenous (IV) contrast computed tomography (CT) imaging compared with central lab testing. Methods A before and after study was performed in ED patients triaged to the critical care area. During the before period, traditional lab testing was performed, whereas in the after period, bedside POCT devices were introduced in all 15 critical care beds with 5 testing cartridges (chemistry with hemoglobin and hematocrit, troponin I, brain natriuretic peptide, lactate, and international normalized ratio [INR]). Clinical protocols indicated when POCT should be used. Results The numbers of critical ED patients before and after introducing POCT were 1405 and 981 respectively. Test turnaround (minutes) was significantly reduced with bedside POCT for all five tests. Use of POCT reduced the median [interquartile range] time to completion of IV contrast CT by 81 minutes (96 [55-214] vs 177 [78-300]; P =.004). Point-of-care testing significantly reduced median ED LOS in patients who received an IV contrast CT (260 [180-410] vs 347 [347 (202-523]; P =.03). Conclusions Introduction of comprehensive bedside POCT in critical ED patients is associated with significant reductions in test turnaround, and time to completion of CT scanning when IV contrast is required. ED LOS was also reduced in the latter population.