title: Use of point-of-care testing and early assessment model reduces length of stay for ambulatory patients in an emergency department.
abstract: BACKGROUND
  To assess whether the use of point-of-care testing (POCT) and early assessment team (EAT) model shortens emergency department (ED) length of stay (LOS).
  
  
  METHODS
  This prospective, observational study with comparison between three study periods was performed in three phases in a metropolitan ED with 57,000 annual visits. Data were collected from adult ambulatory patients who were discharged home. Phase 1 served as a control (n = 1559 in one month). In phase 2, a comprehensive POCT panel including complete blood count, sodium, potassium, glucose, C-reactive protein, creatinine, alkaline phosphatase, alanine aminotransferase, bilirubin, amylase, and D-dimer was launched (n = 1442 in one month). In phase 3 (n = 3356 in subsequent two months), POCT approach continued. In addition, the working process was changed by establishing an EAT consisting of an emergency medicine resident and a nurse. The team operated from 12 noon to 10 p.m. was. The primary outcome was LOS (hh:mm) in the ED. Waiting times for patients requiring laboratory testing were analysed also, including time from admission to laboratory blood sampling (A2S interval), time from blood sampling to results ready (S2R interval) and time from results to discharge (R2D interval).
  
  
  RESULTS
  Median LOS of patients requiring laboratory tests in phase 1 was 3:51 (95 % confidence interval 03:38-04:04). During phase 2, introduction of POCT reduced median LOS by 29 min to 03:22 (03:12-03:31, p = 0.000). In phase 3, the EAT model reduced median LOS further by 17 min to 03:05 (02:59-03:12, p = 0.033). Altogether, the process was expedited by 46 min compared with the phase 1. Surprisingly, A2S interval was unaffected by the interventions among all patients needing laboratory testing. In comparison to phase 1, shortening of S2R interval was observed in phase 2 and 3, and that of R2D interval in all patients with laboratory assessments in phase 3.
  
  
  CONCLUSIONS
  The present study included adult ambulatory patients and is the first one to examine the impact of comprehensive POC test panel, first alone and then with additional process change. As a result, LOS was reduced significantly for patients needing laboratory tests. Considerable shortening in LOS came from introduction of POCT, and EAT process decreased the LOS further. We used a comprehensive POC test panel in order to maximise the patient population benefiting from the positive impacts of POC on laboratory turnaround time and length of stay. In EAT, diverse setups exist, and these differences affect the interpretation of results. The process changes in phase 3 were done by rearranging work shifts and no extra resources were added. Regarding to staffing the process improvement was thus cost neutral.
  
  
  CONCLUSIONS
  The advantage of POCT alone compared with central laboratory seemed to lie in shorter waiting times for results and earlier discharge home. Moreover, POCT and EAT model shorten LOS additively compared with conventional processes. However, a longer time is seemingly needed to adopt a new working process in the ED, and to establish its full benefit.
authors.affiliation: University of Helsinki, Helsinki, Finland. meri.kankaanpaa@helsinki.fi.|Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. meri.kankaanpaa@helsinki.fi.
authors.forename: Meri
authors.identifier: http://orcid.org/0000-0002-2756-8451
authors.initials: M
authors.lastname: Kankaanpää
authors.affiliation: Department of Clinical Chemistry and Haematology, HUSLAB, Helsinki, Finland.
authors.forename: Maria
authors.initials: M
authors.lastname: Raitakari
authors.affiliation: Department of Clinical Chemistry and Haematology, HUSLAB, Helsinki, Finland.
authors.forename: Leila
authors.initials: L
authors.lastname: Muukkonen
authors.affiliation: Department of Clinical Chemistry and Haematology, HUSLAB, Helsinki, Finland.
authors.forename: Siv
authors.initials: S
authors.lastname: Gustafsson
authors.affiliation: University of Helsinki, Helsinki, Finland.|Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Heitto
authors.affiliation: University of Tampere, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Palomäki
authors.affiliation: University of Helsinki, Helsinki, Finland.|Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Suojanen
authors.affiliation: University of Helsinki, Helsinki, Finland.|Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D010045:Outpatients; D010351:Patient Discharge / Q000639:trends; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013997:Time Factors
keywords: EAT; ED; Early assessment team; Emergency department; LOS; Length of stay; POCT; Point-of-care testing