title: Impact from point-of-care devices on emergency department patient processing times compared with central laboratory testing of blood samples: a randomised controlled trial and cost-effectiveness analysis.
abstract: OBJECTIVE
  To determine if time to disposition decisions for emergency department (ED) patients can be reduced when blood tests are processed using point-of-care (POC) devices and to conduct a cost-effectiveness analysis of POC compared with laboratory testing.
  
  
  METHODS
  This randomised trial enrolled adults suspected of an acute coronary syndrome or presenting with conditions considered to only require blood tests available by POC. Participants were randomised to have blood tests processed by POC or laboratory. Outcomes measured were time to disposition decision and ED length-of-stay (LOS). The cost-effectiveness analysis calculated the total and mean costs per ED presentation, as well as total and mean benefits in time saved to disposition decision.
  
  
  RESULTS
  There were 410 POC participants and 401 controls. The mean times to a disposition decision for POC versus controls were 3.24 and 3.50 h respectively, a difference of 7.6% (95% CI 0.4% to 14.3%, p=0.04), and 4.32 and 4.52 h respectively for ED LOS, a difference of 4.4% (95% CI -2.7% to 11.0%, p=0.21). Improved processing time was greatest for participants enrolled by senior staff with a reduction in time to disposition decision of 19.1% (95% CI 7.3% to 29.4%, p<0.01) and ED LOS of 15.6% (95% CI 4.9% to 25.2%, p=0.01). Mean pathology costs were $12 higher in the POC group (95% CI $7 to $18) and the incremental cost-effectiveness ratio was $113 per hour saved in time to disposition decision for POC compared with standard laboratory testing.
  
  
  CONCLUSIONS
  Small improvements in disposition decision time were achieved with POC testing for a moderate increase in cost. Greatest benefit may be achieved when POC is targeted to senior medical staff.
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Stephen Edward
authors.initials: SE
authors.lastname: Asha
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Adam Chiu Fat
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Walter
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kelly
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Morton
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Allan
authors.initials: A
authors.lastname: Ajami
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia South Eastern Area Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia.
authors.forename: Roger Denis
authors.initials: RD
authors.lastname: Wilson
authors.affiliation: Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Honneyman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000379:methods; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006403:Hematologic Tests / Q000191:economics / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D019095:Point-of-Care Systems / Q000191:economics
keywords: cost effectiveness; diagnosis; emergency care systems, efficiency