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A Time-and-Motion Study of the Processes Required to Obtain Cardiac Biomarker Assays Using Central Laboratory, Near-Patient Testing, and Bedside Point-of-Care Testing

Hart, Kimberly W. MA; Lindsell, Christopher J. PhD; Ryan, Richard J. MD

Point of Care: The Journal of Near-Patient Testing & Technology: June 2012 - Volume 11 - Issue 2 - p 61–68
doi: 10.1097/POC.0b013e31822813a4
Original Articles

Background Point-of-care (POC) testing can reduce cardiac biomarker assay turnaround time for patients with suspected acute coronary syndromes (ACSs). However, equivalent reductions in patient throughput have not been realized. To better understand how POC testing fits into the overall system of measuring and reporting cardiac biomarkers, we conducted a time-and-motion study to identify all steps in the cardiac biomarker assay process for 3 testing methods: central laboratory testing, near-patient POC testing, and bedside POC testing.

Methods The assay process for 50 patients with suspected ACS was observed from the decision to order the test to review of results. All actions in the process and the speed of those actions were reported and compared between the 3 testing methods.

Results The time from the test order to review of results was shorter for assays processed using near-patient POC testing than assays processed in the central laboratory (median difference, 42.1 minutes; 95% confidence interval, −57.6 to −26.7 minutes). Assays processed using bedside POC testing tended to be faster than those processed near-patient (median difference, 9.3 minutes; 95% confidence interval, −2.8 to 21.4 minutes). Bedside POC testing eliminated the need to transfer blood to a central testing location. We observed 5 medical errors in the central laboratory and near-patient testing scenarios.

Conclusions Bedside or near-patient POC testing decreases turnaround time for cardiac biomarker assays in the ED setting and eliminates the need to transfer blood for testing to a central laboratory.

From the Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.

Reprints: Kimberly W. Hart, MA, University of Cincinnati, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH. E-mail:

Preliminary findings from this study were presented at the American College of Emergency Physicians Scientific Meeting, 2008 (Lindsell CJ, Raab D, Sperling M, Jacobus L, Ryan R. A time-and-motion study of the processes required to obtain cardiac biomarker assays using both central laboratory and point-of-care testing. Ann Emerg Med. 2008;52[4]).

This research was funded by Abbott Point of Care.

The authors declare no conflict of interest.

© 2012 Lippincott Williams & Wilkins, Inc.