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Cited by 11Clinical Laboratory Practices and Quality ControlEmergency and Acute Care StudiesHealthcare Operations and Scheduling Optimization

A Randomized Controlled Trial to Assess the Impact of Upfront Point-of-Care Testing on Emergency Department Treatment Time

Open access
Goldstein, Lara, Wells, Mike, Vincent-Lambert, Craig·2018·American Journal of Clinical Pathology
DOI 10.1093/ajcp/aqy042
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Abstract

OBJECTIVES: To compare standard emergency department (ED) workflow to a protocolized pathway using upfront point-of-care (POC) tests performed prior to doctor evaluation to determine if this could produce a significant reduction in treatment time. METHODS: We performed a prospective, randomized, controlled trial. Patients were randomized to receive the standard of care or one of the enhanced workflow pathways with POC tests. RESULTS: There were 1,044 patients enrolled. All workflows, except electrocardiogram and low-dose x-ray (LODOX), exceeded the outcome measure (20% reduction in treatment time). It was significantly shorter compared with the control workflow if the patient received any (i-STAT + CBC)-containing workflows (P = .0001, P = .020, P = .0009, P = .011), as well as the i-STAT + LODOX workflows (P = .0001, P = .034). CONCLUSIONS: The full benefit of POC testing can be realized if it is implemented prior to doctor evaluation, as part of a standardized procedure in the ED. This allows for a more rapid availability of investigation results subsequently leading to decreased treatment times.

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Cites

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  • POCT often underestimates sodium concentrations by 1-4 mmol/L due to methodological differences in ion-selective electrodes.

    “Na⁺ measurement discrepancies are also well documented, with several researchers noting that POCT often underestimates Na⁺ concentrations by 1-4 mmol/L due to methodological differences in ion-selective electrodes [9,10].”

    From Reliability of Point-of-Care Venous Blood Gas Testing for Potassium and Sodium Compared to Central Laboratory Results in Emergency Patients: A Clinical Audit (2025) · cites this paper as [9]

    The 'Abbott Point of Care i-STAT System' section (page not provided) lists sodium among the tests performed, but gives no sodium comparison with laboratory results. Searches for sodium underestimation, a 1–4 mmol/L difference, and ion-selective electrode methods found no passage addressing the claimed discrepancy or its cause. (LLM, conf=0.76)

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Cites

Flagged first, then by citations

Research works printed but not linked: 27

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  9. Potgieter JH, de Villiers M, Scheelke M, et al. An explanation for the extremely low, but variable radiation dosages mea- sured in a linear slit scanning radiography system. Proc SPIE. 2005;5745:1138-1145.
  10. Hwang CW, Payton T, Weeks E, et al. Implementing triage stand- ing orders in the emergency department leads to reduced physi- cian-to-disposition times. Adv Emerg Med. 2016;2016:7213625.
  11. Yoon P, Steiner I, Reinhardt G. Analysis of factors influ- encing length of stay in the emergency department. CJEM. 2003;5:155-161.
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  15. Kankaanpää M, Raitakari M, Muukkonen L, et al. Use of point-of-care testing and early assessment model reduces length of stay for ambulatory patients in an emergency depart- ment. Scand J Trauma Resusc Emerg Med. 2016;24:125.
  16. Mogensen CB, Borch A, Brandslund I. Point of care technol- ogy or standard laboratory service in an emergency depart- ment: is there a difference in time to action? A randomised trial. Scand J Trauma Resusc Emerg Med. 2011;19:49.
  17. Saunders CE, Makens PK, Leblanc LJ. Modeling emergency department operations using advanced computer simulation systems. Ann Emerg Med. 1989;18:134-140.
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  19. Retezar R, Bessman E, Ding R, et al. The effect of triage diag- nostic standing orders on emergency department treatment time. Ann Emerg Med. 2011;57:89-99.e2.
  20. Jang JY, Shin SD, Lee EJ, et al. Use of a comprehensive met- abolic panel point-of-care test to reduce length of stay in the emergency department: a randomized controlled trial. Ann Emerg Med. 2013;61:145-151.
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Cited by

Sorted by citations

Authors
Goldstein, L., Wells, M., & Vincent-Lambert, C.
Affiliations
  • University of the Witwatersrand (ZA)
  • University of Johannesburg (ZA)
Corresponding author
Goldstein, Lara
ORCID
Venue
American Journal of Clinical Pathology
Publisher
Oxford University Press (OUP)
Published
2018-06-19
Volume
150
Issue
3
Pages
224-234
ISSN
  • 0002-9173 (ISSN-L)
  • 1943-7722
DOI
10.1093/ajcp/aqy042
OpenAlex
W2809295376
Cited by
11
References
3
Citations by year
2026: 1 · 2025: 3 · 2024: 2 · 2021: 1 · 2020: 1 · 2019: 3
FWCI
0.86
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • American Journal of Clinical Pathology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Abbott Diagnostics
Topics
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
Keywords
point-of-care testing, i-STAT, complete blood count, low-dose X-rays, electrocardiogram, emergency department efficiency

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