Impact of blood testing on patient disposition from the emergency department

Abstract

Objective: To determine whether blood test results lead to a change in planned disposition of patients from the ED. Methods: A prospective review of the anticipated and actual disposition of patients from the ED before and after blood test results, including stratification by seniority of medical staff. Results: There were 256 patients enrolled, 53% had blood tests requested. Expected disposition was not altered by test results in 87% of patients having blood tests. Medical staff were poor at identifying those patients whose disposition would be altered by their blood results (sensitivity 44%, specificity 72%, negative predictive value 89%). Seniority of medical staff was not associated with an alteration in disposition due to the blood results (P = 0.37). Conclusions: Blood test results have minimal impact on expected patient disposition from the ED. Recognition of this may improve resource utilisation with earlier discharge planning.

Outcomes in patients with an emergency department diagnosis of fever of unknown origin

“…Around 22% of non-admissions had blood taken for culture. This is lower than reported in a previous Australian study (64.9%), 15 although their cohort of febrile patients included those with and without a focal cause of fever.…”

Impact of senior clinical review on patient disposition from the emergency department

“…Published studies have looked at specific aspects of care. In a study of blood tests in the ED, Knott and Meyer failed to show any association between medical seniority and a change in disposition or correctly identifying those patients whose outcome might be altered by the blood test result 4. While this was a small study, the results were unexpected.…”

Exploring the clinical utility of blood ketone levels in the emergency department assessment of paediatric patients

“…However, there is a group of children in whom this decision is difficult to make on the basis of history and examination findings alone. [1][2][3] As clinicians, we are often looking for simple tools or tests that can help us in the assessment of these children. [3][4][5][6][7][8] These may include the use of scoring systems, bedside investigations or the judicious use of more sophisticated tests.…”