An assessment of the time-saving and economic impact of upfront, point-of-care testing in the Emergency Department

Abstract

The Emergency Department (ED) is an environment that is perpetually “on the edge of chaos”. Despite this, the optimal functioning of the ED and the ability to provide timeous care, is critical to saving lives and preventing patient morbidity. Delivering upfront point-of-care (POC) testing within an ED – performing diagnostic tests at or near the location of the patient prior to patients receiving their initial doctor evaluation, has the potential to expedite patient throughput and thus save time and possibly money. The aim of this research was to compare and assess the traditional patient flow pathway of the ED to a modified pathway that made use of upfront POC tests (blood tests, ECG and/or LODOX®) in various permutations. The studies evaluated whether the modified pathway had beneficial effect on treatment times and costs, and evaluated doctor perceptions of its implementation. Two separate studies were conducted in order to assess the impact of upfront POC testing in the ED – a prospective, randomised, controlled trial, and a survey. The trial had three separate components to evaluate the effects of upfront POC on treatment times; the potential economic benefit for EDs in low- and middle-income countries (LMIC) and overall cost-effectiveness. The survey assessed doctors’ perceptions and acceptance of the system changes and the potential barriers to implementing upfront POC testing. The inclusion criteria were patients presenting to the ED with common medical complaints such as chest pain, abdominal pain, and generalised body pain and weakness. The upfront POC intervention implemented novel testing during the nonvalue-added time that patients spend waiting to see doctors. The results of these investigations were available to doctors to use in their subsequent patient consultations, potentially facilitating quicker disposition decisions. The results from the study demonstrated that the implementation of upfront POC testing in the ED saved time. The economic analysis demonstrated that its implementation could be cost-effective and also potentially beneficial in LMICs. The doctors surveyed were strongly supportive of the upfront POC system. This suggests that the upfront POC testing could be well-received if adopted in clinical practice.