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Trial registered on ANZCTR
Registration number
ACTRN12611001228976
Ethics application status
Approved
Date submitted
29/11/2011
Date registered
30/11/2011
Date last updated
9/04/2014
Type of registration
Prospectively registered
Titles & IDs
Public title
Impact of an Integrated Point of Care Testing service in the Emergency Department: a randomised trial
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Scientific title
Impact of an Integrated Point of Care Testing service for patients presenting to the Emergency Department on time to disposition decision: a randomised trial
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Secondary ID [1]
273465
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NIL
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Universal Trial Number (UTN)
U1111-1126-0569
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Trial acronym
IPoCT in the ED
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Time taken for a disposition decision to be reached by doctors treating emergency depatment patients.
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Condition category
Condition code
Public Health
279454
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0
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Health service research
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The intervention is to process blood tests of emergency department patients who meet inclusion/exclusion criteria using a point of care blood analyser stationed within the emergency department. The blood tests available are haemoglobin, electrolytes, creatinine, calcium, glucose, INR, troponin, D-Dimer, beta-HCG. Patient may recieve one or more of theses tests, but only once as part of their emergency department evaluation. Patients are involved in the study only as long as it takes for their doctor to make an admission or discharge decision (typically several hours at most).
Patients will be recruited over a period of 8 months.
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Intervention code [1]
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Treatment: Devices
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Intervention code [2]
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Early detection / Screening
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Comparator / control treatment
The control arm will have their required blood tests processed in the usual way using the central laboratory service. This involves taking a blood sample by venepuncture or via an intravenous cannula, generating a request form, and sending both the bllod sample and paperwork to the central laboratory via a pneumatic tube delivery system.
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Control group
Active
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Outcomes
Primary outcome [1]
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Time to admission/discharge decision
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Assessment method [1]
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Timepoint [1]
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Measured at time of admission/discharge decision
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Secondary outcome [1]
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Length of stay in ED
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Assessment method [1]
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Timepoint [1]
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Measured at time patient leaves the ED
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Secondary outcome [2]
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Time to admission/discharge decision for patients with acute coronary syndrome
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Assessment method [2]
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Timepoint [2]
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Measured at time of admission/discharge decision
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Secondary outcome [3]
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Length of stay for those sent home from ED
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Assessment method [3]
295010
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Timepoint [3]
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Measured at time patient leaves the ED
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Secondary outcome [4]
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Length of stay for those sent to emergency short stay ward
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Assessment method [4]
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Timepoint [4]
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Measured at time patient leaves the ED
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Secondary outcome [5]
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Economic evaluation
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Assessment method [5]
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Timepoint [5]
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All costs from time of arrival to ED to the time of departure from the ED
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Eligibility
Key inclusion criteria
1.Age greater or equal to 18 years
2.Presenting to the Emergency department
3.Suspected acute coronary syndrome, or patient only requires blood tests that are available on point of care analyser
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Acute ST elevation mycardial infarct
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Study design
Purpose of the study
Diagnosis
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Study allocation will be recorded on a sheet of paper, each sheet sealed inside opaque sequentially numbered envelopes. These will be stored with the team co-ordinator in the ED. When a patient meets inclusion criteria, the staff member enrolling the patient will ask the team co-ordinator for an allocation envelope. The team co-ordinator will take the next envelope in the sequence and give this to the treating doctor to open.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
We will use a stratified block randomisation method to ensure balanced numbers of participants in each arm of the study. There will be two strata (those patients suspected of an acute coronary syndrome, and all other patient appropriate for point of care testing). Given that this study is unblinded, random block sizes will be used to prevent the possibility of predicting the allocation sequence.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
12/12/2011
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Actual
12/12/2011
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Date of last participant enrolment
Anticipated
28/02/2012
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Actual
26/04/2012
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
620
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Ministerial taskforce for Emercency Care (MTEC)
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Address [1]
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NSW Ministry of Health,
73 Miller St,
North Sydney, 2060
NSW
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Sty George Hospital
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Address
Gray St,
Kogarah, NSW, 2217
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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South Eastern Sydney and Illawarra Area Health Service Human Research Ethics Committee Central
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Ethics committee address [1]
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St George Hospital Gray St Kogarah, 2217 NSW
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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11/10/2011
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Approval date [1]
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18/11/2011
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Ethics approval number [1]
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HREC/11/STG/170
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Summary
Brief summary
The project aims to assess the impact of an Integrated Point of Care Testing service (IPcOT) within the emergency department. Point of care testing (PoCT) involves the installation of a blood analyser within the emergency department that can process a selection of specific tests. The emergency department staff operates the machine, and a result is available in a few minutes. IPoCT involves integrating this machine with the hospital pathology service so that the results of testing performed on this machine are recorded within the SEALS database, and these results can be accessed through the patients electronic medical record. It would seem intuitive that having a IPoCT machine in the ED would have obvious benefits with rapid availability of blood tests allowing rapid decision making that would translate into shorter ED LOS. However, this does not take into account that a IPoCT machine must be operated by ED staff, rather than the lab staff, increasing the work load of ED staff and diverting them away from their usual duties. The IPoCT machine may be able to process a single sample in several minutes, however, in a busy ED where many patients require blood tests simultaneously it is likely that multiple staff will be competing to process blood samples on the one machine, leading to a back-log of tests so that turn-around times for IPoCT could be much longer than expected. The aim of this study is to determine the impact that the availability of point of care testing has on time to admission/discharge decision, and a secondary objective is to perform an economic evaluation (ie what is the cost per unit time saved in decision making time?).
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Trial website
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Trial related presentations / publications
Asha SE, Chan ACF, Walter E, Kelly PJ, Morton RL, Ajami A, Wilson RD, Honneyman D. Impact from point of care devices on emergency department patient processing times compared with central laboratory testing of blood samples: a randomised controlled trial and cost-effectiveness analysis. Emergency medicine journal. Published online first: 7 June 2013 doi:10.1136/emermed-2013-202632.
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Public notes
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Contacts
Principal investigator
Name
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Dr Dr Stephen Asha
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Address
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Emergency Department St George Hospital Gray St, Kogarah, 2217 NSW
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Country
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Australia
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Phone
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+61 2 9113 1650
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Fax
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+61 2 9113 1505
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Email
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[email protected]
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Contact person for public queries
Name
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Dr Stephen Asha
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Address
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Emergency Department
St George Hospital
Gray St, Kogarah, 2217
NSW
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Country
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Australia
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Phone
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+61 2 9113 1650
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Fax
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+61 2 9113 1505
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Email
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[email protected]
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Contact person for scientific queries
Name
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Dr Stephen Asha
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Address
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Emergency Department
St George Hospital
Gray St, Kogarah, 2217
NSW
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Country
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Australia
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Phone
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+61 2 9113 1650
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Fax
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+61 2 9113 1505
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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