Kankaanpää Meri, Holma-Eriksson Marika, Kapanen Sami, Heitto Merja, Bergström Sari, Muukkonen Leila, Harjola Veli-Pekka
Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029, Helsinki, Finland.
Department of Clinical Chemistry and Haematology, Helsinki University Hospital, HUSLAB, Helsinki, Finland.
BMC Emerg Med. 2018 Nov 19;18(1):43. doi: 10.1186/s12873-018-0198-x.
In this study, we hypothesized that point of care testing (POCT) would reduce length of stay (LOS) in emergency department (ED) when compared to central laboratory testing and be a factor in patient discharge destination.
A single centre observational study was performed in ED non-ambulatory patients. Blood testing was performed either with POC instruments for blood gases and chemistry panel, full blood count, and CRP, or at central laboratory, or as a combination of both. Blood draw and POCTs were performed by experienced nurses.
During the 4-week study period, 1759 patients underwent sample testing (POCT: n = 160, central lab: n = 951; both n = 648). Median waiting time for blood sampling was 19 min less in POCT than central laboratory (0:52 (95% confidence interval (CI) 0:46-1:02) vs. 1:11 (95% CI 1:05-1:14), p < 0.001). POCT results were available faster in both discharge groups, as expected. When imaging was not required, patients in POCT group were discharged home 55 min faster (4:57 (95% CI 3:59-6:17) vs. 5:52 (95% CI 5:21-6:35), p = 0.012) and 1 h 22 min faster when imaging was performed (5:48 (95% CI 5:26-6:18) vs. 7:10 (95% CI 6:47-8:26), p = 0.010). Similar reduction in sampling time and LOS was not seen among those admitted to hospital.
POCT shortened the laboratory process and made results available faster than the central lab. This allowed patients to be discharged home quicker. Thus, with proper training and education of the ED care team, POCT can be used as an effective tool for improving patient flow.
在本研究中，我们假设与中央实验室检测相比，即时检验（POCT）可缩短急诊科（ED）的住院时间（LOS），并且是影响患者出院目的地的一个因素。
对急诊科非门诊患者进行了一项单中心观察性研究。血液检测使用POC仪器进行血气和化学分析、全血细胞计数及CRP检测，或在中央实验室进行，或两者结合进行。采血和POCT由经验丰富的护士操作。
在为期4周的研究期间，1759例患者接受了样本检测（POCT组：n = 160，中央实验室组：n = 951；两者结合组：n = 648）。POCT的血液采样中位等待时间比中央实验室少19分钟（0:52（95%置信区间（CI）0:46 - 1:02）对1:11（95%CI 1:05 - 1:14），p < 0.001）。正如预期的那样，两个出院组的POCT结果都能更快获得。当不需要影像学检查时，POCT组患者出院回家的时间快55分钟（4:57（95%CI 3:59 - 6:17）对5:52（95%CI 5:21 - 6:35），p = 0.012），进行影像学检查时快1小时22分钟（5:48（95%CI 5:26 - 6:18）对7:10（95%CI 6:47 - 8:26），p = 0.010）。住院患者中未观察到采样时间和住院时间有类似的缩短。
POCT缩短了实验室流程，结果比中央实验室更快获得。这使得患者能够更快出院回家。因此，通过对急诊科护理团队进行适当的培训和教育，POCT可作为改善患者流程的有效工具。
