i STAT CG4+ and CHEM8+ cartridges for point-of-care testing in the emergency department

Introduction

From April 2014 to March 2015 there were almost 14.6 million recorded attendances at major emergency departments (EDs) in England (NHS England 2015). The indicators used to assess ED performance include ambulance offload times, the numbers of patients on trolleys in relation to designated assessment spaces, and if more than 10% of patients have waited more than 2 hours for admission (College of Emergency Medicine 2011).

From October to December 2014, the number of patients seen within 4 hours of attending an NHS ED was 92.6%, below the target of 95% (NHS England 2015). This, together with Accident and Emergency Quality Indicators data (Health and Social Care Information Commission 2015), suggests that crowding presents increasing difficulties for NHS EDs.

Crowding occurs in EDs from time to time and is associated with increased mortality, reduced quality of care, increased length of stay for non‑elective admissions and staff burnout. An ED is considered to be crowded if ambulances cannot offload patients, there are long delays for patients to be seen by a doctor, there are more patients on trolleys than there are cubicle spaces, or if patients are waiting for more than 2 hours for an inpatient bed after a decision has been made to admit them to hospital (College of Emergency Medicine 2014). NHS targets state that 95% of patients should wait no longer than 4 hours in an ED (measured quarterly), and no ED patients should wait more than 12 hours on a trolley.

Crowding can be related to input factors (how many patients attend the ED), throughput factors (how patients flow through the ED) and output factors (how patients leave the ED; College of Emergency Medicine 2014). Interventions to improve patient throughput include those aimed at streaming or fast‑tracking patients, such as team triage, nurse requested X‑rays and point‑of‑care testing. A systematic review concluded that there was moderate quality evidence that fast‑tracking patients with less severe symptoms leads to shorter waiting times and length of stay in the ED, and fewer patients leaving the ED without being seen by a doctor, but evidence on other interventions was limited (Oredsson et al. 2011). Point‑of‑care testing was seen to improve turnaround time but there was limited evidence to show any effect on length of ED stay. Point‑of‑care tests with rapid turnaround of results have the potential to lead to faster clinical decision‑making and increased patient throughput in the ED. They could have a role in managing crowding in the ED and improving the quality of ED care (Rooney and Schilling 2014).