Point of care testing: randomised controlled trial of clinical outcome
Open accessAbstract
Abstract Objectives: To describe the proportion of patients attending an accident and emergency department for whom blood analysis at the point of care brought about a change in management; to measure the extent to which point of care testing resulted in differences in clinical outcome for these patients when compared with patients whose samples were tested by the hospital laboratory. Design: Open, single centre, randomised controlled trial. Blood samples were randomly allocated to point of care testing or testing by the hospital9s central laboratory. Setting: The accident and emergency department of the Bristol Royal Infirmary, a large teaching hospital which cares for an inner city population. Subjects: Representative sample of patients who attended the department between April 1996 and April 1997 and who required blood tests. Data collection was structured in 8 hour blocks so that all hours of the day and all days of the week were equally represented. Main outcome measures: The proportion of patients for whom point of care testing brought about a change in treatment in which timing was considered to be critical to clinical outcome. Mortality, the length of stay in hospital, admission rate, the amount of time spent waiting for results of blood tests, the amount of time taken to decide on management plans, and the amount of time patients spent in the department were compared between patients whose samples were tested at the point of care and those whose samples were sent to the laboratory. Results: Samples were obtained from 1728 patients. Changes in management in which timing was considered to be critical occurred in 59 out of 859 (6.9%, 95% confidence interval 5.3% to 8.8%) patients in the point of care arm of the trial. Decisions were made 74 minutes earlier (68 min to 80 min, P<0.0001) when point of care testing was used for haematological tests as compared to central laboratory testing, 86 minutes earlier (80 min to 92 min, P<0.0001) for biochemical tests, and 21 minutes earlier (−3 min to 44 min, P=0.09) for analyses of arterial blood gases. There were no differences between the groups in the amount of time spent in the department, length of stay in hospital, admission rates, or mortality. Conclusion: Point of care testing reduced the time taken to make decisions on patient management that were dependent on the results of blood tests. It also brought about faster changes in treatment for which timing was considered to be critical in about 7% of patients. These changes did not affect clinical outcome or the amount of time patients spent in the department. Key messages Point of care testing reduced the amount of time doctors spent waiting for results of blood tests when compared to the time spent waiting for results from the hospital laboratory in an accident and emergency department The time taken to decide on a management plan was also reduced as a result of the shorter time spent waiting for results of point of care tests About 7% of patients who needed urgent blood testing had changes in treatment in which timing was considered to be critical when point of care testing was used Patients did not spend less time in the accident and emergency department even when test results were available more quickly and patient management decisions were made more quickly. This suggests that the availability of test results is not the factor which slows down the arrangement of further care Improvements in process, such as a reduction in the time doctors wait for test results and the ability to make clinical decisions more quickly, do not seem to improve clinical outcome in this sample of patients
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Prolonged laboratory turnaround time is linked to increased mortality in time-sensitive conditions such as sepsis and acute coronary syndrome.
“This delay is conclusively linked to adverse patient outcomes, including increased mortality in time-sensitive conditions like sepsis and acute coronary syndrome, higher rates of hospital-acquired complications, and extended hospital lengths of stay that drive up healthcare costs.”
From Impact of Laboratory Turnaround Time on Clinical Decision-Making and Patient Outcomes (2024) · cites this paper as [3]
The Discussion and outcome table report that faster point-of-care results did not produce a significant difference in mortality or hospital length of stay compared with laboratory testing in this emergency-department sample. The paper does not establish a conclusive link between longer laboratory turnaround and those adverse outcomes, and it does not report findings specifically for sepsis or acute coronary syndrome. No page number is available in our indexed copy. (LLM, conf=0.84)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredPoint-of-care testing has been shown to lead to shorter length of stay in some studies but not in all.
“In the ED, point-of-care testing has been shown to lead to shorter length of stay in some studies, [15–18] but not in all [19–21].”
From Shorter laboratory turnaround time is associated with shorter emergency department length of stay: a retrospective cohort study (2022) · cites this paper as [19]
In acute coronary syndrome, delays in troponin turnaround time directly contribute to delays in reperfusion therapy, leading to greater infarct size, more heart failure, and higher mortality.
“Delays in troponin TAT directly contribute to delays in reperfusion therapy, leading to greater infarct size, more heart failure, and higher mortality [3].”
From Impact of Laboratory Turnaround Time on Clinical Decision-Making and Patient Outcomes (2024) · cites this paper as [3]
The Results and Discussion address faster availability of general emergency blood-test results and earlier management decisions, not troponin turnaround in acute coronary syndrome. The copy does not link test timing to reperfusion delays, infarct size, heart failure, or increased mortality; searches for troponin, reperfusion, and those outcomes found no passage establishing the claimed chain. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Impact of point-of-care testing on patients' length of stay in a large emergency department
Parvin, C. A., Lo, S. F., Deuser, S. M., Weaver, L. G., Lewis, L. M., & Scott, M. G. (1996) · Clinical Chemistry · doi:10.1093/clinchem/42.5.711 · Cited by 164 · see citing works
Jacobs, E., Vadasdi, E., Sárközi, L., et al. (1993) · Clinical Chemistry · doi:10.1093/clinchem/39.6.1069 · Cited by 153 · see citing works
Point-of-care versus central laboratory testing: an economic analysis in an academic medical center.
Tsai, W. W., Nash, D. B., Seamonds, B., & Weir, G. J. (1994) · PubMed · Cited by 72 · see citing works
The Portable Laboratory: An Evaluation of the Accuracy and Reproducibility of i-STAT©
Bingham, D., Kendall, J., & Clancy, M. J. (1999) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/000456329903600109 · Cited by 58 · see citing works
Self-citationEvaluation of a Portable Clinical Blood Analyzer in the Emergency Department
Sands, V. M., Auerbach, P. S., Birnbaum, J., & Green, M. (1995) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.1995.tb03190.x · Cited by 42 · see citing works
Saxena, S., & Wong, E. T. (1993) · American Journal of Clinical Pathology · doi:10.1093/ajcp/100.6.606 · Cited by 41 · see citing works
The Evaluation of a Portable Clinical Analyzer in the Emergency Department
Woo, J., McCabe, J. B., Chauncey, D., Schug, T., & Henry, J. B. (1993) · American Journal of Clinical Pathology · doi:10.1093/ajcp/100.6.599 · Cited by 35 · see citing works
Bedside blood gas and electrolyte monitoring in critically ill patients
Zaloga, G. P., HILL, T. R., Strickland, R. A., et al. (1989) · Critical Care Medicine · doi:10.1097/00003246-198909000-00017 · Cited by 30 · see citing works
MINIMIZING ADMISSION LABORATORY TESTING IN TRAUMA PATIENTS
Frankel, H. L., Rozycki, G. S., Mg, O., et al. (1994) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/00005373-199411000-00006 · Cited by 24 · see citing works
Kendall, J., Bevan, G., & Clancy, M. J. (1999) · Journal of Health Services Research & Policy · doi:10.1177/135581969900400109 · Cited by 20 · see citing works
Self-citationSantrach, P. J., & Burritt, M. F. (1995) · Mayo Clinic Proceedings · doi:10.4065/70.5.493 · Cited by 20 · see citing works
Fleisher, M., & Mk, S. (1995) · PubMed · Cited by 19 · see citing works
Point of Care Laboratory Testing in the Emergency Department
Jatlow, P. I. (1993) · American Journal of Clinical Pathology · doi:10.1093/ajcp/100.6.591 · Cited by 13 · see citing works
Point-of-care testing: Does it really improve patient care
Fleisher, M. (1993) · Clinical Biochemistry · doi:10.1016/0009-9120(93)90004-p · Cited by 11 · see citing works
Advanced life support courses.
Fothergill, J., Touquet, R., & Stacey, S. (1996) · Emergency Medicine Journal · doi:10.1136/emj.13.2.149-a · Cited by 5 · see citing works
Near patient tests are poorly evaluated
Bower, H. (1997) · BMJ · doi:10.1136/bmj.314.7097.1781k · Cited by 3 · see citing works
Benefits of immediate printing of blood test results within an A&E department.
Clancy, M., & Bingham, D. (1996) · Emergency Medicine Journal · doi:10.1136/emj.13.2.149-b · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [11]11. Kendall JM, Bevan G, Clancy M. A randomised controlled trial of point of care testing in an accident and emergency department: a cost analysis. J Health Services Res Policy (in press).
Cited by
Sorted by citations
Lee-Lewandrowski, E., Corboy, D., Lewandrowski, K., Sinclair, J., McDermot, S., & Benzer, T. I. (2003) · Archives of Pathology & Laboratory Medicine · doi:10.5858/2003-127-0456-ioapsl · Cited by 202 · see citing works
Florkowski, C., Don-Wauchope, A., Gimenez, N., Rodriguez-Capote, K., Wils, J., & Zemlin, A. (2017) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408363.2017.1399336 · Cited by 189 · see citing works
Does POCT reduce the risk of error in laboratory testing?
Plebani, M. (2009) · Clinica Chimica Acta · doi:10.1016/j.cca.2009.03.014 · Cited by 97 · see citing works
Effect of point of care testing on length of stay in an adult emergency department
Murray, R. P., Leroux, M., Sabga, E., Palatnick, W., & Ludwig, L. (1999) · The Journal of Emergency Medicine · doi:10.1016/s0736-4679(99)00107-9 · Cited by 71 · see citing works
Guss, D. A., Chan, T. C., & Killeen, J. P. (2008) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.03.010 · Cited by 69 · see citing works
Asha, S. E., Chan, A. C. F., Walter, E., Kelly, P. J., Morton, R. L., Ajami, A., Wilson, R. D., & Honneyman, D. (2014) · Emergency Medicine Journal · doi:10.1136/emermed-2013-202632 · Cited by 67 · see citing works
A point-of-care chemistry test for reduction of turnaround and clinical decision time
Lee, E. J., Shin, S. D., Song, K. J., Kim, S. C., Cho, J. S., Lee, S. C., Park, J. O., & Cha, W. C. (2011) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2009.11.020 · Cited by 51 · see citing works
Vrijsen, B. E. L., Haitjema, S., Westerink, J., Hulsbergen-Veelken, C. A. R., van Solinge, W. W., & ten Berg, M. J. (2022) · BMC Emergency Medicine · doi:10.1186/s12873-022-00763-w · Cited by 20 · see citing works
A systematic evaluation of immunoassay point-of-care testing to define impact on patients’ outcomes
Pecoraro, V., Banfi, G., Germagnoli, L., & Trenti, T. (2017) · Annals of Clinical Biochemistry: International Journal of Laboratory Medicine · doi:10.1177/0004563217694377 · Cited by 17 · see citing works
Impact of Laboratory Turnaround Time on Clinical Decision-Making and Patient Outcomes
Alanazi, A. G. J., Hanbouli, T. M. H. A., Albarqi, A. S. M., Aldoghmani Turki Kateb, D., Rowili, N. H. O. A., Jhory, K. E. A., Bokhari, A. M. K., Alanazi, A. A., Alenezi, T. M. R., Alawidia Ahmad Issa, A., et al. (2024) · International Journal of Computational and Experimental Science and Engineering · doi:10.22399/ijcesen.4675 · Cited by 1 · see citing works
“For instance, the rapid availability of cardiac biomarker results in patients presenting with chest pain is essential for the timely diagnosis of acute myocardial infarction and the initiation of reperfusion therapy, a standard where "time is muscle" [3].”
- Authors
- Kendall, J., Reeves, B., & Clancy, M.
- Affiliations
- Bristol Royal Infirmary (GB)
- Corresponding author
- Kendall, J.
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1998-04-04
- Volume
- 316
- Issue
- 7137
- Pages
- 1052-1057
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC28507
- OpenAlex
- W2015782235
- Cited by
- 200
- References
- 17
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 8 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 9 · 2019: 5 · 2018: 4 · 2017: 7 · 2016: 9 · 2015: 5 · 2014: 6 · 2013: 9 · 2012: 9
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- point-of-care testing, emergency department, blood analysis, central laboratory testing, biochemical tests, arterial blood gases, clinical outcomes, length of hospital stay, mortality
- MeSH terms
- Adult, Aged, Blood Specimen Collection, Decision Making, Emergency Service, Hospital, England, Female, Hematologic Tests, Hospitals, Teaching, Humans, Laboratories, Hospital, Length of Stay, Male, Middle Aged, Patient Admission, Time Factors, Urban Health, Treatment Outcome, Outcome Assessment, Health Care, Point-of-Care Systems
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
