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

Abstract

Point of care testing refers to diagnostic analytical testing performed near the patient's bedside. POCT is used as it provides results more rapidly as compared to the central laboratory testing and it is assumed that this will improve patient care by reducing length of stay. There is little published evidence whether this is correct or not. The purpose of this study was to investigate the effect of POCT on patient length of stay, assess the capability of non-specialist staff for providing the service and evaluate cost analysis. The project was carried out in the A&E department of the West Middlesex University Hospital, Isleworth. As part of the implementation of the POCT service, this study validated the performance of a Sysmex XS 1000i analyser (Sysmex Corporation, Kobe, Japan, providing ‘full blood count’ testing). The POCT service also included analyses of urea and electrolytes carried out on an ISTAT Analyser (Abbott Point of Care, Princeton, USA). POCT devices are usually used in isolation, but in order to facilitate result availability in this study they were connected to the hospital computer system. For those patients only requiring simple tests (U&E and FBC only) results were produced significantly quicker by the POCT system as compared to the central laboratory testing (n=161, mean time to results 24 minutes vs. n=180, mean time to results 60 minutes, p = <0.05). Investigation of 1106 patients showed 216 cases that only received the POCT test profile. The average length of stay for these patients was 157 minutes (95% of patients within 236 minutes) compared to 178 minutes (95% of patients within 238 minutes) observed for a control group (n=2386) who received the same test from the clinical laboratory (a significantly shorter length of stay, p= <0.05). Length of stay for patients that had POCT + Laboratory test (n=1106) showed no significant reduction (p= >0.05) as compared to the control group (n= 6035). The average length of stay for POCT+ Laboratory test group was 198 minutes (95% of patients within 240 minutes) compared to the control group where length of stay was 200 minutes (95% of patients within 236 minutes). POCT service can be provided by non-specialist staff and this has no effect on the quality of results, as judged by error rates and results interpretation. POCT does produce results more rapidly than CLT, and reduces average (but not 95th percentile) length of stay for less than 1% of patients. It is more expensive to provide a POCT service as compared to the CLT and does not save the hospital money by reducing length of stay. The cost analysis showed that the total cost for providing POCT service is 85k per annum. The savings after POCT implementation are trivial and data shows that less than 1% of patients’ length of stay will be significantly reduced. Therefore it is not financially feasible to introduce a POCT service in the A&E department of a hospital.

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