Blood sample tube transporting system versus point of care technology in an emergency department; effect on time from collection to reporting? A randomised trial

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Abstract

Background

Time is a crucial factor in an emergency department and the effectiveness of diagnosing depends on, among other things, the accessibility of rapid reported laboratory test results; i.e.: a short turnaround time (TAT). Former studies have shown a reduced time to action when point of care technologies (POCT) are used in emergency departments. This study assesses the hypothesis, that using Point of Care Technology in analysing blood samples versus tube transporting blood samples for laboratory analyses results in shorter time from the blood sample is collected to the result is reported in an emergency department.

Methods

The study was designed as a randomised controlled trial with consecutive allocation into two groups and rated 1:1. Blood samples were collected on all included patients and then randomised into either POCT analyses or tube transporting for central laboratory analyses.

Results

Blood samples from a total of 319 patients were included.

The mean time from collecting to reporting was 24 minutes for the POCT analysis and 70 minutes for the tube transported analysis. An unpaired Students t-test showed a significant reduction in time from collecting to reporting using POCT (p<.0001).

Conclusion

We found a significantly reduced time from collecting to reporting using Point of Care Technology (POCT) in an emergency department compared to tube transported blood samples for central laboratory analyses.

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Most cited references 4

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Point of care testing: randomised controlled trial of clinical outcome.

Bradley Kendall, Matthew B. Reeves, M Clancy (1998)

To describe the proportion of patients attending an accident and emergency department for whom blood analysis at the point of care brought about a change in management; to measure the extent to which point of care testing resulted in differences in clinical outcome for these patients when compared with patients whose samples were tested by the hospital laboratory. Open, single centre, randomised controlled trial. Blood samples were randomly allocated to point of care testing or testing by the hospital's central laboratory. The accident and emergency department of the Bristol Royal Infirmary, a large teaching hospital which cares for an inner city population. Representative sample of patients who attended the department between April 1996 and April 1997 and who required blood tests. Data collection was structured in 8 hour blocks so that all hours of the day and all days of the week were equally represented. The proportion of patients for whom point of care testing brought about a change in treatment in which timing was considered to be critical to clinical outcome. Mortality, the length of stay in hospital, admission rate, the amount of time spent waiting for results of blood tests, the amount of time taken to decide on management plans, and the amount of time patients spent in the department were compared between patients whose samples were tested at the point of care and those whose samples were sent to the laboratory. Samples were obtained from 1728 patients. Changes in management in which timing was considered to be critical occurred in 59 out of 859 (6.9%, 95% confidence interval 5.3% to 8.8%) patients in the point of care arm of the trial. Decisions were made 74 minutes earlier (68 min to 80 min, P < 0.0001) when point of care testing was used for haematological tests as compared to central laboratory testing, 86 minutes earlier (80 min to 92 min, P < 0.0001) for biochemical tests, and 21 minutes earlier (-3 min to 44 min, P = 0.09) for analyses of arterial blood gases. There were no differences between the groups in the amount of time spent in the department, length of stay in hospital, admission rates, or mortality. Point of care testing reduced the time taken to make decisions on patient management that were dependent on the results of blood tests. It also brought about faster changes in treatment for which timing was considered to be critical in about 7% of patients. These changes did not affect clinical outcome or the amount of time patients spent in the department.

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Point of care testing in the emergency department.

Gregory J Fermann, Joe Suyama (2002)

Point of care (POC) testing in the Emergency Department (ED) is becoming more common. The implementation and maintenance of POC testing in the ED, however, is a complex issue. We performed a systematic review of the English language literature published between 1985 and June 2001 with a focus on POC testing and ED application. Articles that addressed the following were included in the review: implementation of POC testing, maintenance and regulation of POC testing, and application of POC testing. Current POC technology has been found to be reliable in various patient care settings, including the ED. Cost and connectivity issues are complex and difficult to assess, making these the greatest barriers to the full acceptance of POC testing in the ED. Patient care issues must be weighed against the cost of implementing POC testing and supporting the infrastructure needed to maintain this technology in the ED.

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Effects of a pneumatic tube system on routine and novel hematology and coagulation parameters in healthy volunteers.

W. A. Kratz, Randa R Salem, J. W. A. M. den Teuling (2007)

Technologic advances affecting analyzers used in clinical laboratories have changed the methods used to obtain many laboratory measurements, and many novel parameters are now available. The effects of specimen transport through a pneumatic tube system on laboratory results obtained with such modern instruments are unclear. To determine the effects of sample transport through a pneumatic tube system on routine and novel hematology and coagulation parameters obtained on state-of-the-art analyzers. Paired blood samples from 33 healthy volunteers were either hand delivered to the clinical laboratory or transported through a pneumatic tube system. No statistically significant differences were observed for routine complete blood cell count and white cell differential parameters or markers of platelet activation, such as the mean platelet component, or of red cell fragmentation. When 2 donors who reported aspirin intake were excluded from the analysis, there was a statistically, but not clinically, significant impact of transport through the pneumatic tube system on the mean platelet component. There were no statistically significant differences for prothrombin time, activated partial thromboplastin time, waveform slopes for prothrombin time or activated partial thromboplastin time, fibrinogen, or fibrin monomers. Although further study regarding the mean platelet component may be required, transport through a pneumatic tube system has no clinically significant effect on hematology and coagulation results obtained with certain modern instruments in blood samples from healthy volunteers.

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Author and article information

Journal

Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med

Journal ID (iso-abbrev): Scand J Trauma Resusc Emerg Med

Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Publisher: BioMed Central

ISSN (Electronic): 1757-7241

Publication date Collection: 2012

Publication date (Electronic): 8 October 2012

Volume: 20

Page: 71

Affiliations

[1 ]Emergency Department, Kolding Hospital, a part of Lillebaelt Hospital, Skovvangen 2-8, Kolding, 6000, Denmark

Article

Publisher ID: 1757-7241-20-71

DOI: 10.1186/1757-7241-20-71

PMC ID: 3751946

PubMed ID: 23044180

SO-VID: ab1524ab-8a85-48e7-9cfd-307be905eaf4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Blood sample tube transporting system versus point of care technology in an emergency department; effect on time from collection to reporting? A randomised trial

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Abstract

Background

Methods

Results

Conclusion

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Preventive and Emergency Medicine Insights

Most cited references 4

Point of care testing: randomised controlled trial of clinical outcome.

Point of care testing in the emergency department.

Effects of a pneumatic tube system on routine and novel hematology and coagulation parameters in healthy volunteers.

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