National survey on availability, use and clinical impact of point-of-care blood analysis systems in Swedish emergency departments.

Abstract

Background: Expedited diagnostic results are important in time sensitive operations like the Emergency Department (ED). Point-of-care testing (POCT) is used for a broad range of blood tests reducing wait times and providing faster decisions on patient management compared to central laboratory analysis. If POCT is to substitute central laboratory analysis as part of the decision making process in the ED, cognizance on the distribution and availability of the required instruments, staff training and workflow integration is essential. The aim of this study was to determine the accessibility of POCT, with particular emphasis on blood gas analysis, in all Swedish EDs and to describe its incorporation into workflow.

Methods: This was an exploratory survey study conducted in 2024 using a digital questionnaire focusing on POCT availability, perceived reliability, sampling, analysis and workflow integration. Descriptive data is reported as percentage, mean with standard deviation. Qualitative data in open-ended questions was analyzed in a descriptive manner and systematically summarized.

Results: All Swedish EDs (n = 71) responded to our survey. All EDs utilized some kind of POCT with the most prevalent being blood gas, Hb, glucose and CRP. 75% of all EDs had at least one blood gas instrument on site. 44% had guidelines to define indication and usage, 67% replaced certain central laboratory analyses in favor of POCT. ED staff assessed the reliability of results of POCT blood gas analysis as 8 on a 1-10 likert scale (SD 1). All EDs provided staff training on sampling and analysis, but only 30% of EDs had repeated training sessions to avoid misoperation and preanalytical errors. In 32% of reporting EDs, POCT blood gas analysis was performed on more than 30% of patients, mainly triggered by standard operating procedures.

Conclusion: All Swedish EDs utilized basic POCT to accelerate patient flow. The majority of Swedish EDs have access to POCT blood gas analysis, the replacement of central laboratory analyses was common. Perceived reliability of POCT blood gas analysis results was considered high, despite the fact that staff training varied substantially. The overall utilization of other POCT remains low - that despite good evidence for cost-effectiveness, reliability and shortened length of stay.

Trial registration: Clinical trial number: Not applicable.