Impact of point-of-care panel tests in ambulatory care: a systematic review and meta-analysis

Abstract

Objectives: This article summarises all the available evidence on the impact of introducing blood-based point-of-care panel testing (POCT) in ambulatory care on patient outcomes and healthcare processes.

Design: Systematic review and meta-analysis of randomised-controlled trials and before-after studies.

Data sources: Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Database of Abstracts of Reviews and Effects, Science Citation Index from inception to 22 October 2019.

Eligibility criteria for selecting studies: Included studies were based in ambulatory care and compared POCT with laboratory testing. The primary outcome was the time to decision regarding disposition that is, admission/referral termed disposition decision (DD) time. Secondary outcomes included length of stay (LOS) at the ambulatory care unit/practice and mortality.

Results: 19 562 patients from nine studies were included in the review, eight of these were randomised-controlled trials, and one was a before-after study. All the studies were based in either emergency departments or the ambulance service; no studies were from primary care settings. General panel tests performed at the POCT resulted in DDs being made 40 min faster (95% CI -42.2 to -36.6, I²=0%) compared with the group receiving usual care, including central laboratory testing. This in turn resulted in a reduction in LOS for patients who were subsequently discharged by 34 min (95% CI -63.7 to -5.16). No significant difference in mortality was reported.

Discussion: Although statistical and clinical heterogeneity is evident and only a small number of studies were included in the meta-analysis, our results suggest that POCTs might lead to faster discharge decisions. Future research should be performed in primary care and identify how POCTs can contribute meaningful changes to patient care rather than focusing on healthcare processes.

Prospero registration number: CRD42016035426.

Keywords: POCT; accident & emergency medicine; chemical pathology; paediatric A&E and ambulatory care; point of care tests; primary care.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. *The 22 October 2019 review updates only screened studies for their inclusion in this systematic review, focusing on the impact of point-of-care panel tests (POCT) in ambulatory care, and did not assess suitability for inclusion in the overall review. The 213 articles currently included in the overall POCT review are correct up to the previous update on 17 March 2017.

Figure 2

Risk of bias summary for included randomised-controlled trials.

Figure 3

Forest plot of comparison of time to disposition decision in minutes for patients who needed laboratory testing in addition to point-of-care testing (POCT) and for patients whose blood work fell entirely within the capabilities of POCT.

Figure 4

Forest plot of comparison of length of stay time in minutes for patients who needed laboratory testing in addition to point-of-care testing (POCT) and for patients whose blood work fell entirely within the capabilities of POCT.

Figure 5

Forest plot of comparison of length of stay time in minutes for patients who underwent point-of-care testing versus laboratory testing, split into subgroups for patients who were admitted/discharged.

Figure 6

Relative risk of death in POCT compared with laboratory testing for general and cardiac panel tests performed in ED, and cardiac panels tested by the ambulance service. ED, emergency department; POCT, point-of-care testing.