Point of care testing in the accident and emergency department: a cost analysis and exploration of financial incentives to use the technology within the hospital.
OBJECTIVE
To compare the costs of current arrangements for testing emergency blood samples from patients attending an accident and emergency (A&E) department in a large teaching hospital in England with point of care testing (POCT).


METHODS
Estimates were made of the fixed and variable costs of two options: a supplemental option, in which POCT was introduced to A&E only; and a replacement option, in which POCT was introduced to A&E and the intensive therapy unit (ITU), thereby entirely replacing an existing process.


RESULTS
For the supplemental option, current arrangements cost 68,466 Pounds in total per year; average costs per test were 5.53 Pounds (venous in the central laboratory) and 3.60 Pounds (arterial on the ITU). Introducing POCT would increase total hospital costs by 35,929 Pounds, and average costs per test would be 5.32 Pounds (venous) and 4.28 Pounds (arterial). For the replacement option, current arrangements cost 132,630 Pounds in total, and average cost per test (for all tests) was 4.06 Pounds. Introducing POCT would make hospital savings ranging from 8332 Pounds to 20,000 Pounds, and average cost per test would be 3.78 Pounds.


CONCLUSIONS
Introducing POCT results in lower average costs per test. The supplemental option will result in significantly increased costs to the hospital. The replacement option can lead to significant savings. The internal cross-charging arrangements between departments that exist in this hospital may mean that supplemental implementation of POCT could be potentially 'profitable' for the A&E department, but would result in higher expenditure for the hospital as a whole.
Kendall
J M
JM
Department of Accident and Emergency Medicine, Bristol Royal Infirmary, UK.
Bevan
G
G
Clancy
M J
MJ
D001774:Blood Chemical Analysis / Q000191:economics; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration; D004739:England; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics*; D019095:Point-of-Care Systems / Q000191:economics*; D011050:Policy Making