Use of a comprehensive metabolic panel point-of-care test to reduce length of stay in the emergency department: a randomized controlled trial.
OBJECTIVE
Awaiting results from laboratory testing may sometimes be a rate-limiting step in emergency department (ED) throughput prolonging length of stay and contributing to crowding. We determine whether introduction of a comprehensive metabolic panel point-of-care test can reduce ED length of stay compared with traditional central laboratory testing.


METHODS
We performed a randomized, controlled trial among 10,244 noncritically ill ED patients aged 15 years and older whose physicians ordered a comprehensive metabolic panel at a single, large, academic, urban medical center. Participants were randomly assigned to performance of a comprehensive metabolic panel by a point-of-care test (n=5,154) or central laboratory testing (n=5,090). The primary outcome was length of stay in the ED.


RESULTS
A point-of-care test reduced median ED length of stay among all study patients by 22 minutes (median 350 minutes [interquartile range 206 to 1,002 minutes] with point-of-care test versus median 372 minutes [interquartile range 217 to 1,150 minutes] with central laboratory testing; median difference 22 minutes; 95% confidence interval [CI] 4 to 40 minutes). A point-of-care test also reduced ED length of stay in patients discharged to home (256 versus 268 minutes; median difference 12 minutes; 95% CI 2 to 22 minutes) and with an Emergency Severity Index triage level of 3 (333 versus 355 minutes; median difference 22 minutes; 95% CI 4 to 40 minutes).


CONCLUSIONS
Use of a point-of-care test for a comprehensive metabolic panel reduced ED length of stay compared with central laboratory testing in the adult ED of a single academic center.
Department of Emergency Medicine, Seoul National University College of Medicine, Korea.
Ji Yeon
JY
Jang
Sang Do
SD
Shin
Eui Jung
EJ
Lee
Chang Bae
CB
Park
Kyoung Jun
KJ
Song
Adam J
AJ
Singer
D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007755:Laboratories, Hospital; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D013997:Time Factors