Point-of-care testing in the overcrowded emergency department – can it make a difference?

Abstract

Emergency departments (EDs) face several challenges in maintaining consistent quality care in the face of steadily increasing public demand. Improvements in the survival rate of critically ill patients in the ED are directly related to the advancement of early recognition and treatment. Frequent episodes of overcrowding and prolonged waiting times force EDs to operate beyond their capacity and threaten to impact upon patient care. The objectives of this review are as follows: (a) to establish overcrowding as a threat to patient outcomes, person-centered care, and public safety in the ED; (b) to describe scenarios in which point-of-care testing (POCT) has been found to ameliorate factors thought to contribute to overcrowding; and (c) to discuss how POCT can be used directly, and indirectly, to expedite patient care and improve outcomes. Various studies have shown that overcrowding in the ED has profound effects on operational efficiency and patient care. Several reports have quantified overcrowding in the ED and have described a relationship between heightened periods of overcrowding and delays in treatment, increased incidence of adverse events, and an even greater probability of mortality. In certain scenarios, POCT has been found to increase the number of patients discharged in a timely manner, expedite triage of urgent but non-emergency patients, and decrease delays to treatment initiation. This review concludes that POCT, when used effectively, may alleviate the negative impacts of overcrowding on the safety, effectiveness, and person-centeredness of care in the ED.

D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications

“…In such settings, the GP had to refer the patient to a central laboratory facility [91]. The main interest in POC D-dimer assays is the possibility to rapidly screen patients for thromboembolic disease, thus leading to a decrease in overcrowding in urgent care facilities [3,90,93,94]. The majority of POC tests use whole blood, are homogenous, use monoclonal antibodies and have a short TAT [3,90].…”

Point-of-care diagnostics for niche applications

“…One of these is to expedite the diagnostic process with cost-effective, POC tests (Fermann and Suyama, 2002). For diseases where the turnaround time is the limiting factor, the implementation of such POC testing has been shown to improve healthcare delivery (Rooney and Schilling, 2014). Here we focus on POC testing that is used to diagnose adverse cardiac events in the emergency department.…”

Evaluation of serum neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in critically ill patients

“…Since the ED is the first site of contact for most critically ill patients, the use of RT-POCT can not only accelerate triage, but also facilitate evidence-based practices in the ED. 7 …”