Point of Care Testing in the Emergency Department

Abstract

Background: The objective of this multidisciplinary study was to compare the turnaround times (TAT) of cardiac biomarkers using point of care testing in the emergency department (ED) versus that of central laboratory turnaround times. Methods: Begin use of a point of care laboratory analyzer in the emergency department. With the suggestion from our ED Medical Director and the Administrative Director of Laboratory Services, the Dade Behring Stratus CS was selected for use. The ED and the laboratory successfully collaborated to establish a multidisciplinary approach. A parallel study was adapted to compare the turnaround times of troponin-I and CK-MB in the laboratory with the time of the Stratus CS in the ED. This parallel study involved consistent communication among the ED, the central laboratory, and the CQI Team from Dade Behring, which was vital to the success of this process. Results: The first 4 weeks of the parallel study yielded a TAT average of 57.7 minutes. This was an improvement of 22.7 minutes compared with the central laboratory's average TAT of 80.4 minutes. Sixty-seven percent of the times on the Stratus CS were less than 60 minutes, with 28% of those times less than 30 minutes. The central laboratory was able to provide a TAT of less than 60 minutes 24% of the time and zero less than 30 minutes. Throughout the parallel study, TAT on the Stratus CS continued to improve as did staff satisfaction with the change in procedure. Conclusions: The parallel study is now complete and as of October 1, 2004, Centennial Medical Center Emergency Department is reporting official results from the laboratory analyzer used in the ED. In 4 months of “live data,” our average median time per month is 43 minutes. With the use of point of care testing, the ED is able to meet the standards of the American Heart Association/American College of Cardiology. Both suggest a turnaround time of 60 minutes or less, preferably 30 minutes. The central laboratory is and will be unable to meet the preferential 30 minutes at any time. Most important, a more rapid return of cardiac biomarker data will improve the diagnosis and management of those patients presenting with ACS symptoms.