A time-and-motion study of the processes required to obtain cardiac biomarker assays using central laboratory, near-patient testing, and bedside point-of-care testing

Background: Point-of-care (POC) testing can reduce cardiac biomarker assay turnaround time for patients with suspected acute coronary syndromes (ACSs). However, equivalent reductions in patient throughput have not been realized. To better understand how POC testing fits into the overall system of measuring and reporting cardiac biomarkers, we conducted a time-and-motion study to identify all steps in the cardiac biomarker assay process for 3 testing methods: central laboratory testing, near-patient POC testing, and bedside POC testing. METHODS: The assay process for 50 patients with suspected ACS was observed from the decision to order the test to review of results. All actions in the process and the speed of those actions were reported and compared between the 3 testing methods. Results: The time from the test order to review of results was shorter for assays processed using near-patient POC testing than assays processed in the central laboratory (median difference, 42.1 minutes; 95% confidence interval, -57.6 to -26.7 minutes). Assays processed using bedside POC testing tended to be faster than those processed near-patient (median difference, 9.3 minutes; 95% confidence interval, -2.8 to 21.4 minutes). Bedside POC testing eliminated the need to transfer blood to a central testing location. We observed 5 medical errors in the central laboratory and near-patient testing scenarios. Conclusions: Bedside or near-patient POC testing decreases turnaround time for cardiac biomarker assays in the ED setting and eliminates the need to transfer blood for testing to a central laboratory. © 2012 Lippincott Williams & Wilkins.

Duke Scholars

Author Christopher Lindsell Biostatistics & Bioinformatics, Division of Biostatistics