How the clinical laboratory and the emergency department can work together to move patients through quickly.

The emergency departments (ED) at many medical centers are experiencing increased crowding and prolonged ED patient length of stay. During periods of heavy patient volume, the ED may go on divert status and be unable to care for new patients except for life-threatening illness. As part of a larger interdepartmental effort to improve ED operations, we implemented an ED satellite laboratory (kiosk) in the ED of Massachusetts General Hospital. The tests performed included cardiac markers, urinalysis, urine pregnancy testing, and whole blood glucose testing. The resulting average test turnaround time decreased by 51.5 minutes (87%) compared with the central laboratory, and physician satisfaction increased markedly. ED patient length of stay decreased by an average of 41 minutes for each patient tested, and the number of ED divert hours has steadily decreased. We therefore have concluded that point-of-care testing in an ED satellite laboratory may improve ED operations and contribute to improved outcomes when implemented as part of a larger interdepartmental effort.