Parvin C A, Lo S F, Deuser S M, Weaver L G, Lewis L M, Scott M G
Washington University School of Medicine, Division of Laboratory Medicine, St. Louis, MO 63110, USA.
Clin Chem. 1996 May;42(5):711-7.
We prospectively investigated whether routine use of a point-of-care testing (POCT) device by nonlaboratory operators in the emergency department (ED) for all patients requiring the available tests could shorten patient length of stay (LOS) in the ED. ED patient LOS, defined as the length of time between triage (initial patient interview) and discharge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POCT device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of the hand-held device. Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use. Among nearly 15 000 ED patient visits during the study period, 4985 patients (2067 during the experimental period and 2918 during the two control periods) had at least one Na, K, Cl, BUN, or Gluc test ordered from the ED. However, no decrease in ED LOS was observed in the tested patients during the experimental period. Median LOS during the experimental period was 209 min vs 201 min for the combined control periods. Stratifying patients by presenting condition (chest pain, trauma, etc.), discharge/admit status, or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period. From these observations, we consider it unlikely that routine use of a hand-held POCT device in a large ED such as ours is sufficient by itself to impact ED patient LOS.
我们前瞻性地研究了急诊科(ED)中非实验室操作人员对所有需要进行可用检测的患者常规使用即时检验(POCT)设备是否能缩短患者在ED的住院时间(LOS)。ED患者的LOS定义为分诊(首次患者问诊)至出院(回家或入院)之间的时长,在为期5周的实验期内进行了检查,在此期间ED人员使用手持式POCT设备进行钠、钾、氯、葡萄糖(Gluc)和血尿素氮(BUN)检测。初步数据表明该手持式设备的准确性可接受。将实验期内患者LOS分布与POCT设备使用前为期5周的对照期以及使用后为期3周的对照期内的LOS分布进行了比较。在研究期间近15000次ED患者就诊中,4985例患者(实验期内2067例,两个对照期内2918例)至少接受了一项来自ED的钠、钾、氯、BUN或Gluc检测。然而,在实验期内,受试患者的ED LOS未观察到下降。实验期内的中位LOS为209分钟,而合并对照期为201分钟。按就诊情况(胸痛、创伤等)、出院/入院状态或是否进行其他中心实验室检测对患者进行分层,未发现实验期内任何患者亚组的患者LOS有所下降。基于这些观察结果,我们认为在像我们这样的大型ED中常规使用手持式POCT设备本身不太可能对ED患者LOS产生影响。