Cardiac Marker Testing As Part Of An Emergency Department Point-of-Care Satellite Laboratory In A Large Academic Medical Center

Abstract

Previous reports concerning the utility of point-of-care testing (POCT) in the emergency department (ED) setting have produced mixed results. Testing for cardiac markers at the point of care has attracted considerable interest in the literature but few hospitals have reported results of experience in clinical practice. The availability of new therapies for acute coronary syndromes and the development of chest pain pathways in many institutions has made POCT for cardiac markers a potentially important topic in laboratory medicine. The authors present a prospective study on the implementation of POCT for cardiac markers in an ED of an urban academic medical center. Data concerning operations, physician satisfaction, and practical experiences from implementation were reviewed over a 1-year time frame. Implementation of cardiac markers in a multi-test satellite laboratory as part of an interdepartmental process improvement effort was associated with improved physician satisfaction with laboratory services (from a score of 2.06 to 4.00: scale 1 to 5), a 48-minute decrease in ED length of stay for patients that received cardiac marker testing, and a decrease in ED divert hours of 25%. Significant implementation issues were encountered concerning test menu, cutoff values, the use of quantitative versus qualitative testing, and issues concerning laboratory operations. Each of these challenges required careful planning of the ED satellite laboratory operations to facilitate successful implementation. Cardiac marker testing at the point of care can be implemented successfully in an ED setting using trained laboratory staff in a satellite laboratory facility. When performed as part of an overall organizational effort in the ED, POCT may contribute to a decrease in ED length-of-stay, a decrease in ED divert hours, and an increase in physician satisfaction. Point-of-care testing (POCT) for cardiac markers using currently available technologies requires careful consideration of technical issues including menu, cutoff values, the use of qualitative versus quantitative technologies, and methods to reconcile test results with those obtained on different technologies in the central laboratory.