Does Point-of-Care Testing Impact Length of Stay in Emergency Departments (EDs)?: A Before and After Study of 26 Rural and Remote EDs

The implementation of Point-of-Care Testing (PoCT) services across rural and remote emergency departments (EDs) by NSW Health Pathology has the potential to significantly improve timely access to results for certain types of pathology laboratory tests and help to deliver timely patient care. The aim of this study was to examine the impact of the implementation of PoCT on the length of stay (LOS) of patients in rural and remote EDs. A total of 3808 patients with a circulatory system illness were treated and discharged at any one of 22 rural and remote EDs during the study period. Generalised Estimating Equation (GEE) modelling was applied to examine whether the implementation of PoCT impacted the ED LOS with adjustment for a range of clinical variables. More patients were treated and discharged from these rural and remote EDs within 4-hours after the PoCT implementation (post-PoCT 86.8% versus pre-PoCT 84.3%). Although average ED LOS was 11 minutes shorter in the post-PoCT period, the impact of PoCT on ED LOS was not conclusive after considering other important clinical factors (p=0.07). This study is the one of the few to examine changes in LOS following the introduction of PoCT in EDs in Australia. The study also identified areas where more robust methods could be applied in the future as the quality of PoCT data improves to further assess the potential effects of this technology on practice and outcomes.