Clinical and operational impact of rapid point-of-care SARS-CoV-2 detection in an emergency department

Camille Gerlier, Benoît Pilmis, Olivier Ganansia, Alban Le Monnier, Jean-Claude Nguyen Van, Camille Gerlier, Benoît Pilmis, Olivier Ganansia, Alban Le Monnier, Jean-Claude Nguyen Van

Abstract

Study objective: Rapid point-of-care (POC) SARS-CoV-2 detection with Abbott ID NOW™ COVID-19 test has been implemented in our Emergency Department (ED) for several months. We aimed to evaluate the operational impact and potential benefits of this innovative clinical pathway.

Methods: We conducted a prospective, descriptive, interventional, non-randomized study, before-after trial with the comparison of patient cohorts from two consecutive periods of seven weeks (observational pre-POC period vs interventional POC period).

Results: In 2020, throughout weeks 37 to 50, 3333 patients were assessed for eligibility and among them 331 (9.9%) were positive for SARS-CoV-2 infections. Among the included patients, 136 (9.2%) were positive for SARS-CoV-2 infection in the pre-POC period and 195 (10.5%) in the POC period. Among positive patients for SARS-CoV-2 related infection in-hospital mortality rate was similar between the two groups but the hospitalization rate was higher in the POC group (81.6% vs. 65.4%; p < 0.001). More patients in the POC period were able to leave the ED within 6 h. We examined rates of antibiotic, anticoagulant, and corticosteroid prescriptions among patients tested for SARS-CoV-2 in the ED. Only the rate of prescribed anticoagulants was found to be higher in the POC period (40% vs. 24.2%; p < 0.003).

Conclusion: We demonstrated that COVID-19 point-of-care testing speeds up clinical decision-making, improving use of recommended treatments for COVID-19, such as anticoagulants. Moreover, it improves the boarding time and significantly shortened the length of stay in the ED for patients requiring outpatient care.

Keywords: Cilnical impact; Emergency department; IDNOW COVID-19; Isothermal nucleic acid amplification technology; NAAT; Nicking enzyme amplification reaction technology; Operational impact; Point-of-care; SARS-CoV-2.

Conflict of interest statement

Declaration of Competing Interest This work presented was not funded. None of the authors declare any personal or financial conflict of interest in relation to this manuscript.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow chart.
Fig. 2
Fig. 2
Emergency practitioners (EP) perceptions regarding COVID-19 POC implementation in the ED.

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