Leon-Justel Antonio, Navarro Bustos Carmen, Noval-Padillo Jose Angel, Martin Perez Salomon, Aviles Gomez Maria Dolores, Jimenez Valencia Nelia, Garrido Castilla Jose M, Diaz Muñoz Miguel, Rivera Vizcaino Maria A, Alvarez Heredia Laura, Gracia Moreno Emilia, Roldan Fontan Maria Esther, Bueno Mariscal Caludio, Guerrero Montavez Juan Miguel, Sanchez-Mora Catalina
Laboratory Medicine Department, Hospital Universitario Virgen Macarena. Instituto Biomedicina Sevilla IBIs/CSIC/Universidad de Sevilla/Universidad Loyola Andalucia, Sevilla, Spain.
Emergency Department, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Clin Chem Lab Med. 2024 Dec 5;63(5):942-951. doi: 10.1515/cclm-2024-1040. Print 2025 Apr 28.
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.
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.
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.
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.
急诊科拥挤是一个普遍存在的问题，使患者处于风险之中。提高急诊科 throughput 需要新的方法。即时检验（POCT）已成为一种有用的技术，有助于在急诊科创造更高效的患者流程和更好的及时性。我们研究的主要目的是在一项多中心研究中证明，POCT 有益于急诊科的护理及时性。
我们进行了一项多中心整群随机研究。共有 3200 名患者。我们将患者随机分为 POCT 组或中心实验室组。主要结局是急诊科做出临床决策的时间。次要结局包括住院时间和实验室周转时间。还计算了出院后 7 天内的再入院率。
本研究的主要发现是一种基于 POCT 的策略，旨在显著提高急诊科的护理及时性。我们发现，无论就诊原因、患者处置方式或医院类型如何，所有结局均有显著改善。POCT 组做出临床决策的时间减少了 75.2 分钟（205 - 129.8），住院时间减少了 77.5 分钟（273.1 - 195.6），实验室周转时间减少了 56.2 分钟（82.2 - 26）。未发现再入院率增加。
我们的策略是优化急诊科及时性的一种好方法。它应被视为进一步开展运营研究的起点，该研究聚焦于 POCT，以提高 throughput 并减少急诊科的拥挤现象。
