Evaluation of the use of point of care testing in an accident and emergency department

Jama, Ladan (2013) Evaluation of the use of point of care testing in an accident and emergency department. (MSc(R) thesis), Kingston University, .


The use of point of care testing (POCT) has increased over recent years due to the availability of robust and portable analytical equipment. It is widely assumed that POCT can provide diagnostic test results more rapidly than central laboratories, thus improving the patient outcome. This project aimed to implement and validate a point of care service for the analysis of full blood count, urea and electrolytes in an Accident and Emergency department. It also proceeded to evaluate the impact of non-laboratory staff providing the service, and whether the service reduced patients' length of stay. The study was conducted over a 6-month period. Assay performance was verified by measuring imprecision and bias in comparison to the central laboratory analysers. The impact of the use of non-laboratory staff was assessed by comparing comments generated automatically by the full blood count analyser with those provided by trained biomedical scientists. Patient length of stay (LOS) was calculated using data obtained from the hospital's computerised patient management systems. This was calculated for patients receiving POCT results, those with different presenting complaints, and those seen on different days of the week and different times of the day. The POCT analysers (Sysmex XS-1000i, Opti CCA-TS and Abbott i-STAT) showed acceptable analytical performance during initial validation. However, the Opti CCA-TS showed discrepancies for sodium results in daily comparisons and was replaced by the i-STAT. Comments provided by Sysmex XS-1000i indicated a false positive rate of 82% and a false negative rate of 27%, however this did not affect immediate patient management. Test turnaround time was significantly shorter for point of care devices compared to the central laboratory (24 minutes [plus or minus] 20 vs 63 minutes, [plus or minus] 24, P = 0). The mean LOS for patients receiving POCT was not significantly different from those receiving central laboratory testing (198 minutes (n = 1106) vs 200 minutes (n = 6035), P =0.239). There was also no significant difference in LOS for the different patient categories investigated. However, a longer mean LOS was observed for patients seen on Mondays (209 minutes, P = 0.001) in comparison to the central laboratory.

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