Use of a Comprehensive Metabolic Panel Point-of-Care Test to Reduce Length of Stay in the Emergency Department: A Randomized Controlled Trial

Study objective: Awaiting results from laboratory testing may sometimes be a rate-limiting step in emergency department (ED) throughput prolonging length of stay and contributing to crowding. We determine whether introduction of a comprehensive metabolic panel point-of-care test can reduce ED length of stay compared with traditional central laboratory testing. Methods: We performed a randomized, controlled trial among 10,244 noncritically ill ED patients aged 15 years and older whose physicians ordered a comprehensive metabolic panel at a single, large, academic, urban medical center. Participants were randomly assigned to performance of a comprehensive metabolic panel by a point-of-care test (n=5,154) or central laboratory testing (n=5,090). The primary outcome was length of stay in the ED. Results: A point-of-care test reduced median ED length of stay among all study patients by 22 minutes (median 350 minutes [interquartile range 206 to 1,002 minutes] with point-of-care test versus median 372 minutes [interquartile range 217 to 1,150 minutes] with central laboratory testing; median difference 22 minutes; 95% confidence interval [CI] 4 to 40 minutes). A point-of-care test also reduced ED length of stay in patients discharged to home (256 versus 268 minutes; median difference 12 minutes; 95% CI 2 to 22 minutes) and with an Emergency Severity Index triage level of 3 (333 versus 355 minutes; median difference 22 minutes; 95% CI 4 to 40 minutes). Conclusion: Use of a point-of-care test for a comprehensive metabolic panel reduced ED length of stay compared with central laboratory testing in the adult ED of a single academic center. [Ann Emerg Med. 2013;61:145-151.] Please see page 146 for the Editor's Capsule Summary of this article.