Cardiac point-of-care testing: Impact on emergency department door to disposition time is modified by patient acuity and hospital setting

Background: Implementing point-of-care testing (POCT) is thought to improve emergency department (ED) patient throughput by decreasing time to disposition, but evidence is lacking. We implemented POCT for cardiac biomarkers and determined whether it improved patient throughput. Methods: Cardiac POCT was implemented at an academic ED (annual census, 80,000 patients) and a community ED (annual census, 40,000 patients). Administrative databases were queried for the 4 months before and 4 months after implementing POCT. General linear modeling was used to estimate the effects of cardiac biomarker testing on time to disposition for patients being evaluated for acute coronary syndrome (ACS), adjusting for hospital setting, triage acuity level, and ED disposition on time to disposition for all patients, and for the subset of patients being evaluated for ACS. Results: There were 54,419 patients with a disposition time available: 26,554 before and 27,865 after cardiac POCT implementation. Time to disposition decreased by 17 minutes (95% confidence interval, 15-20 minutes). Time to disposition decreased for lower-acuity patients, but increased in patients with higher acuity. Interactions suggested that the effects of POCT on throughput were different between EDs and also dependent on final disposition. There were 4886 patients with suspected ACS, a cardiac biomarker measured, and a disposition time available: 2440 before and 2446 after POCT implementation. Time to disposition for these patients decreased by 26 minutes (95% confidence interval, 18-33 minutes). Discussion: Among ED patients, including those being evaluated for ACS, cardiac POCT reduced time to disposition overall. Effects were complicated by hospital setting, triage acuity, and ED disposition. © 2011 by Lippincott Williams & Wilkins.

Duke Scholars

Author Christopher Lindsell Biostatistics & Bioinformatics, Division of Biostatistics