Doctors' perceptions of the impact of upfront point-of-care testing in the emergency department

Abstract

Objectives: Special investigations (e.g. blood tests, electrocardiograms, x-rays) play an integral role in patient management in the emergency department (ED). Having results immediately available prior to assessing a patient may lead to improved efficiency. This could be instituted by utilizing point-of-care (POC) testing with an alternative ED workflow, but the implementation would be dependent on acceptance by the end-users. The aim of this study was to assess doctors' perceptions of POC testing in the ED when the normal treatment pathway was modified to use upfront POC tests performed prior to doctor evaluation in an effort to decrease treatment times.

Methods: A prospective, randomized, controlled trial was performed in the ED where medical patients received either the normal ED workflow pathway or one of the enhanced workflow pathways with POC tests in various combinations prior to doctor evaluation. At the end of the study period, doctors were invited to participate in an anonymous survey to gauge their opinions on the implementation of the early POC testing.

Results: Overall, the doctors surveyed were very satisfied with use of upfront POC in the ED. One hundred per cent of the 28 doctors surveyed found it helpful to assess patients who already had test results available and would want it to be permanently available. Normalized satisfaction scores were more favorable for combinations of 3 or more tests (0.7-1.0) as opposed to combinations with 2 or less tests (0.3-0.7). There was a preference for combinations that included comprehensive blood results.

Conclusion: The implementation of workflow changes to assist doctors in the ED can potentially make them more productive. End-user buy-in is essential in order for the change to be successful. Upfront, protocolised, POC testing is a low-input, high-yield intervention that decreased treatment time and satisfied doctors.

Fig 1. The normal ED patient workflow compared to the POC intervention workflows during the randomized controlled trial period.

CBC—Complete Blood Count, ECG—electrocardiogram, i-STAT—i-STAT POC tests, LODOX—LOw-DOse X-ray.

Fig 2. Bar chart of doctors’ likert scale responses to POC testing in the ED.

Fig 3. Doctors’ opinion on the time-saving of individual POC tests for patients triaged yellow and orange according to the South African Triage Scale.

CBC—Complete Blood Count, ECG—electrocardiogram, i-STAT—i-STAT POC tests, LODOX—Low-dose x-ray.

Fig 4. Doctors’ satisfaction with the various POC workflow options compared to treatment time benefits. Actual treatment time for each workflow pathway is indicated in minutes.

CBC—Complete Blood Count, ECG—electrocardiogram, i-STAT—i-STAT POC tests, LODOX—Low-dose x-ray.