Asha Stephen Edward, Chan Adam Chiu Fat, Walter Elizabeth, Kelly Patrick J, Morton Rachael L, Ajami Allan, Wilson Roger Denis, Honneyman Daniel
Emergency Department, St George Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
Emerg Med J. 2014 Sep;31(9):714-9. doi: 10.1136/emermed-2013-202632. Epub 2013 Jun 7.
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.
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.
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.
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.
确定使用即时检验（POC）设备处理血液检测时，急诊科（ED）患者做出处置决定的时间是否能够缩短，并对POC检测与实验室检测进行成本效益分析。
这项随机试验纳入了怀疑患有急性冠状动脉综合征或患有仅需POC提供的血液检测项目的疾病的成年人。参与者被随机分配接受POC或实验室处理血液检测。测量的结果是做出处置决定的时间和急诊留观时间（LOS）。成本效益分析计算了每次急诊就诊的总成本和平均成本，以及节省至做出处置决定的时间的总效益和平均效益。
POC组有410名参与者，对照组有401名。POC组和对照组做出处置决定的平均时间分别为3.24小时和3.50小时，差异为7.6%（95%CI 0.4%至14.3%，p=0.04），急诊留观时间分别为4.32小时和4.52小时，差异为4.4%（95%CI -2.7%至11.0%，p=0.21）。高级工作人员招募的参与者的处理时间改善最大，做出处置决定的时间减少了19.1%（95%CI 7.3%至29.4%，p<0.01），急诊留观时间减少了15.6%（95%CI 4.9%至25.2%，p=0.01）。POC组的平均检验成本高出12美元（95%CI 7美元至18美元），与标准实验室检测相比，POC检测每节省一小时做出处置决定的时间，增量成本效益比为113美元。
POC检测在成本适度增加的情况下，使处置决定时间有小幅缩短。当POC针对高级医务人员时，可能会获得最大效益。
