Point-of-care versus central laboratory testing: an economic analysis in an academic medical center

W W Tsai, D B Nash, B Seamonds, G J Weir
Clinical Therapeutics 1994, 16 (5): 898-910; discussion 854
A cost-effectiveness study was conducted to determine time and labor costs for point-of-care (POC) versus central laboratory testing. A prospective, observational time and motion study was carried out at a teaching hospital located in Philadelphia, Pennsylvania. The cohort consisted of 210 patients presenting to the emergency department who were triaged at the urgent or emergent level during a 4-week period. Patients who had blood drawn for a seven-chemistry profile (Chem-7), which includes analysis of sodium, potassium, chloride, carbon dioxide, blood urea nitrogen, glucose, and creatinine, or for cell blood count (CBC) tests as part of regular care, also had an additional split sample drawn for POC analysis of sodium, potassium, chloride, blood urea nitrogen, glucose, and/or hematocrit. Blood drawn for POC analysis did not require additional needlestick(s), nor did it alter regular care procedures. Physicians and all emergency department staff participating in the care of the patients were blinded to POC test results. Main outcome measures included test turn-around time (TAT), physician determination of impact of rapid TAT and laboratory values on therapeutic approach, and cost per test for POC versus central laboratory testing. POC TAT was a mean of 8 minutes (time from blood drawn to results shown on the POC device display). Central laboratory TAT was a mean of 59 minutes (time from blood drawn to entry of results into mainframe computer). Therapeutic TAT was a mean of 1 hour and 25 minutes (time from blood drawn to analysis in central laboratory, to when the physician viewed test results). After therapeutic course of care was decided for the patient, physicians reported that POC testing, independent of other rate-limiting steps, would have resulted in earlier therapeutic action for 40 of 210 (19.0%) patients. The cost per test for Chem-7 and CBC tests was $11.14 and $9.48, respectively. The cost per test for POC analysis ranged from $14.37 to $16.67, depending on the POC test volume (estimated volume based on 20% to 50% of emergency department patients that had either Chem-7 or CBC test done applied over the useful life of the POC testing equipment) and the personnel (nurse or emergency department technician) who performed the test. With an increasing volume of POC tests performed per unit time, costs for POC testing would be reduced substantially. POC test costs are volume dependent under current reimbursement mechanisms for emergency department patient care services, for example, fee-for-service payment.(ABSTRACT TRUNCATED AT 400 WORDS)

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