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Point-of-care testing improves care timeliness in the emergency department. A multicenter randomized clinical trial (study POCTUR)

  • Antonio Leon-Justel EMAIL logo , Carmen Navarro Bustos , Jose Angel Noval-Padillo , Salomon Martin Perez ORCID logo , Maria Dolores Aviles Gomez , Nelia Jimenez Valencia , Jose M. Garrido Castilla , Miguel Diaz Muñoz , Maria A. Rivera Vizcaino , Laura Alvarez Heredia , Emilia Gracia Moreno , Maria Esther Roldan Fontan , Caludio Bueno Mariscal , Juan Miguel Guerrero Montavez and Catalina Sanchez-Mora
Published/Copyright: December 5, 2024
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 5

Abstract

Objectives

Emergency department (ED) crowding is a widespread problem that positions patients at risk. The desire to improve the ED throughput requires novel approaches. Point-of-care testing (POCT) has emerged as useful technology that could contribute to create more efficient patient flow and better timeliness in the ED. The main objective of our study is to demonstrate, in a multicenter study, that POCT benefits care timeliness in the ED.

Methods

We conducted a multicenter and cluster randomized study. A total of 3,200 patients. We randomly assigned patients to a POCT group or Central Laboratory Group. The primary outcome was the ED time to clinical decision. The secondary outcome included the length of stay and the laboratory turnaround time. Readmission within the seven after discharge was also calculated.

Results

The primary finding of this study is a strategy based on POCT that aims to significantly improve care timeliness in the ED. We found significant reductions in all outcomes regardless of presentation reason, patient disposition or hospital type. Time to clinical decision decreased by 75.2 min (205–129.8), length of stay by 77.5 min (273.1–195.6) and laboratory turnaround time by 56.2 min (82.2–26) in the POCT group. No increase in readmission was found.

Conclusions

Our strategy represents a good approach to optimize timeliness in the ED. It should be seen as a starting point for further operational research focusing on POCT for improving throughput and reducing crowding in the ED.

Keywords: point-of-care testing; emergency department; overcrowding
Corresponding author: Antonio Leon-Justel, Laboratory Medicine Department, Hospital Universitario Virgen Macarena, Instituto Biomedicina Sevilla IBIs/CSIC/Universidad de Sevilla/Universidad Loyola Andalucia, Dr. Fedriani nº3 41009, Sevilla, Spain, E-mail:

Funding source: Instituto de Salud Carlos III

Award Identifier / Grant number: PI21/00829

  1. Research ethics: The study titled “Design and validation of a single-act model based on point-of-care testing technology to improve emergency resolution in hospitals in the province of Seville”, a multicenter project of the University Hospitals Virgen del Rocío, Macarena, Valme and Osuna (sponsor code PI21/00829, internal code 1306-N-21), was evaluated and approved by the Research Ethics Committee (CEI) of the University Hospitals Virgen Macarena and Virgen del Rocío at their meeting on 02/17/2022 (minutes CEI_02/2022), after reviewing protocol version 1 dated 05/28/2021, with the sponsor being an investigator, and the study was conducted in accordance with the principles of the Declaration of Helsinki (2013 revision).

  2. Informed consent: Not applicable.

  3. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Leon-Justel, Antonio: leads the overall impact assessment of the project, writes the initial manuscript, and oversees patient inclusion. Participates in the initial situation analysis and budget evaluation. Navarro, Carmen: Responsible for the initial situation analysis, implementation of tools, and writing of methodology at the Virgen Macarena Hospital. Coordinates patient inclusion and participates in the design of workflows. Noval-Padillo, JA: project coordinator at the Virgen del Rocio Hospital. Leads the design and development of the POCT platform and participates in impact and budget evaluations. Martin Perez, Salomon: main responsible for the statistical analysis of the study, development and maintenance of multicenter databases, coordination of the standardization of tests between participating hospitals. Preparation of the analysis and interpretation of data, preparation of tables and figures of the manuscript, and critical review of the statistical content of the article. Aviles Gomez, Maria Dolores: responsible for the coordination in the emergency service at the Virgen del Rocio Hospital. Contributes to the analysis of results, critical review and methodological validation. Jimenez Valencia, Nelia: contributes to the analysis of results, critical review and methodological validation. Garrido Castilla, Jose Manuel: responsible for the coordination of the emergency service at the Virgen Macarena hospital. Contributes to the analysis of results, critical review and methodological validation. Diaz Muñoz, Miguel: contributes to the analysis of results, critical review and methodological validation. Rivera Vizcaino, Maria A: contributes to the analysis of results, critical review and methodological validation. Alvarez Heredia, Laura: contributes to the analysis of results, critical review and methodological validation. Gracia Moreno, Emilia: coordinates the evaluation of professional satisfaction, contribution to the results section and statistical analysis of impact. Roldan, M. Esther: responsible at the Hospital de La Merced de Osuna for the analysis of the initial situation, implementation of tools and drafting of the methodology. Coordinates patient inclusion and participates in the design of workflows. Bueno Mariscal, Claudio: responsible for the initial situation analysis, implementation of tools and drafting of methodology at the Virgen de Rocio Hospital. Coordinates patient inclusion and participates in the design of workflows. Jimenez-Barragan, Marta: contributes to the analysis of results, critical review and methodological validation. Morales Barroso, Isabel: contributes to the analysis of results, critical review and methodological validation. Guerrero, Juan Miguel: contributes to the analysis of results, critical review and methodological validation. Sánchez-Mora, Catalina: Co-directs the design of the POCT platform, drafting of the methods section and assessment of care impact. Contributes to the analysis of results, critical review and methodological validation.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: This research has been funded by the Instituto de Salud Carlos III (ISCIII) through the project “PI21/00829” and co-funded by the European Union (EU).

  7. Data availability: Not applicable.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2024-1040).

Received: 2024-08-01
Accepted: 2024-11-13
Published Online: 2024-12-05
Published in Print: 2025-04-28

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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  2. Editorial
  3. Are the benefits of External Quality Assessment (EQA) recognized beyond the echo chamber?
  4. Reviews
  5. Behind the scenes of EQA – characteristics, capabilities, benefits and assets of external quality assessment (EQA): Part I – EQA in general and EQA programs in particular
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  14. Evaluation of performance in preanalytical phase EQA: can laboratories mitigate common pitfalls?
  15. Point-of-care testing improves care timeliness in the emergency department. A multicenter randomized clinical trial (study POCTUR)
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  17. Measurement of 1,25-dihydroxyvitamin D in serum by LC-MS/MS compared to immunoassay reveals inconsistent agreement in paediatric samples
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  29. Letters to the Editor
  30. Concentrations and agreement over 10 years with different assay versions and analyzers for troponin T and N-terminal pro-B-type natriuretic peptide
  31. Does blood tube filling influence the Athlete Biological Passport variables?
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https://doi.org/10.1515/cclm-2024-1040
Keywords for this article
point-of-care testing; emergency department; overcrowding

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Are the benefits of External Quality Assessment (EQA) recognized beyond the echo chamber?
  4. Reviews
  5. Behind the scenes of EQA – characteristics, capabilities, benefits and assets of external quality assessment (EQA): Part I – EQA in general and EQA programs in particular
  6. Behind the scenes of EQA – characteristics, capabilities, benefits and assets of external quality assessment (EQA): Part II – EQA cycles
  7. Behind the scenes of EQA – characteristics, capabilities, benefits and assets of external quality assessment (EQA): Part III – EQA samples
  8. Behind the scenes of EQA–characteristics, capabilities, benefits and assets of external quality assessment (EQA): Part IV – Benefits for participant laboratories
  9. Behind the scenes of EQA – characteristics, capabilities, benefits and assets of external quality assessment (EQA): Part V – Benefits for stakeholders other than participants
  10. Opinion Papers
  11. Not all biases are created equal: how to deal with bias on laboratory measurements
  12. Krebs von den Lungen-6 (KL-6) as a diagnostic and prognostic biomarker for non-neoplastic lung diseases
  13. General Clinical Chemistry and Laboratory Medicine
  14. Evaluation of performance in preanalytical phase EQA: can laboratories mitigate common pitfalls?
  15. Point-of-care testing improves care timeliness in the emergency department. A multicenter randomized clinical trial (study POCTUR)
  16. The different serum albumin assays influence calcium status in haemodialysis patients: a comparative study against free calcium as a reference method
  17. Measurement of 1,25-dihydroxyvitamin D in serum by LC-MS/MS compared to immunoassay reveals inconsistent agreement in paediatric samples
  18. Knowledge among clinical personnel on the impact of hemolysis using blood gas analyzers
  19. Quality indicators for urine sample contamination: can squamous epithelial cells and bacteria count be used to identify properly collected samples?
  20. Reference Values and Biological Variations
  21. Biological variation of cardiac biomarkers in athletes during an entire sport season
  22. Increased specificity of the “GFAP/UCH-L1” mTBI rule-out test by age dependent cut-offs
  23. Cancer Diagnostics
  24. An untargeted metabolomics approach to evaluate enzymatically deconjugated steroids and intact steroid conjugates in urine as diagnostic biomarkers for adrenal tumors
  25. Cardiovascular Diseases
  26. Comparative evaluation of peptide vs. protein-based calibration for quantification of cardiac troponin I using ID-LC-MS/MS
  27. Infectious Diseases
  28. The potential role of leukocytes cell population data (CPD) for diagnosing sepsis in adult patients admitted to the intensive care unit
  29. Letters to the Editor
  30. Concentrations and agreement over 10 years with different assay versions and analyzers for troponin T and N-terminal pro-B-type natriuretic peptide
  31. Does blood tube filling influence the Athlete Biological Passport variables?
  32. Influence of data visualisations on laboratorians’ acceptance of method comparison studies
  33. An appeal for biological variation estimates in deep immunophenotyping
  34. Serum free light chains reference intervals for the Lebanese population
  35. Applying the likelihood ratio concept in external quality assessment for ANCA
  36. A promising new direct immunoassay for urinary free cortisol determination
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