将即时检测整合到社区急诊部中：一项混合方法评估。

Integrating Point-of-care Testing Into a Community Emergency Department: A Mixed-methods Evaluation.

机构信息

Center for Healthcare Innovation & Policy Research, Washington, DC.

Departments of Emergency Medicine and Health Policy & Management, George Washington University, Washington, DC.

出版信息

Acad Emerg Med. 2018 Oct;25(10):1146-1156. doi: 10.1111/acem.13450. Epub 2018 Jun 8.

DOI:10.1111/acem.13450

PMID:29754458

Abstract

OBJECTIVE

Point-of-care testing (POCT) is a commonly used technology that hastens the time to laboratory results in emergency departments (ED). We evaluated an ED-based POCT program on ED length of stay (LOS) and time to care, coupled with qualitative interviews of local ED stakeholders.

METHODS

We conducted a mixed-methods study (2012-2016) to examine the impact of POCT in a single, community ED. The quantiative analysis involved an observational before-after study comparing time to laboratory test result (POC troponin or POC chemistry) and ED LOS after implementation of POCT, using a propensity-weighted interrupted time series analysis (ITSA). A complementary qualitative analysis involved five semistructured interviews with staff using grounded theory on the benefits and challenges to ED POCT.

RESULTS

A total of 47,399 ED visits were included in the study (24,705 in the preintervention period and 22,694 in the postintervention period). After POCT implementation, overall laboratory testing increased marginally from 61% to 62%. Central laboratory troponin and chemistry declined by > 50% and was replaced by POCT. Prior to POCT implementation, time to troponin and chemistry had declined steadily due to other improvements in laboratory efficiency. After POCT implementation, there was an immediate 20-minute further decline (p < 0.001) in both time to troponin and time to chemistry results using the propensity-weighted comparisons. However, the declining trend observed prior to POCT implementation did not continue at the same rate after implementation. Similarly, prior to POCT implementation, ED LOS declined due to other quality improvements. After POCT implementation, LOS continued declined at a similar rate. Because of this prior trend, the ITSA did not show a significant decline in LOS attributable to POCT. Common benefits of POCT perceived by staff in qualitative interviews included improved quality of care (64%) and reductions in time to test results (44%). Common challenges included concerns over POCT accuracy (32%) and technical barriers (29%).

CONCLUSION

In the study ED, implementation of POCT was associated with a reduction in time to test result for both troponin and chemistry. Local staff felt that faster time to test result improved quality of care; however, concerns were raised with POCT accuracy.

摘要

目的

床边检测（POCT）是一种常用于加速急诊科（ED）实验室结果产生时间的技术。我们评估了一项基于 ED 的 POCT 项目对 ED 住院时间（LOS）和护理时间的影响，同时对当地 ED 利益相关者进行了定性访谈。

方法

我们进行了一项混合方法研究（2012-2016 年），以检查单个社区 ED 中 POCT 的影响。定量分析涉及观察性前后研究，比较实施 POCT 前后实验室检测结果（POC 肌钙蛋白或 POC 化学）和 ED LOS 的时间，使用倾向评分加权中断时间序列分析（ITSA）。一项补充的定性分析涉及对 ED POCT 的益处和挑战进行的五次半结构化访谈，采用扎根理论。

结果

研究共纳入 47399 例 ED 就诊（干预前 24705 例，干预后 22694 例）。实施 POCT 后，总体实验室检测量略有增加，从 61%增加到 62%。中心实验室肌钙蛋白和化学检测下降超过 50%，被 POCT 取代。在实施 POCT 之前，由于实验室效率的其他改进，肌钙蛋白和化学检测的时间稳步下降。实施 POCT 后，使用倾向评分比较，肌钙蛋白和化学检测结果的时间立即进一步下降 20 分钟（p<0.001）。然而，在实施 POCT 之前观察到的下降趋势在实施后并没有以相同的速度继续。同样，在实施 POCT 之前，由于其他质量改进，ED LOS 下降。实施 POCT 后，LOS 继续以相似的速度下降。由于这一先前的趋势，ITSA 并没有显示 LOS 因 POCT 而显著下降。工作人员在定性访谈中认为 POCT 的常见益处包括改善护理质量（64%）和减少检测结果的时间（44%）。常见的挑战包括对 POCT 准确性的担忧（32%）和技术障碍（29%）。