Impact of Point-of-Care Laboratory Diagnostics on Emergency Department Processing Times During the COVID-19 Pandemic

Aim: In 2020 Emergency department (ED) in the Clinical hospital centre Rijeka established Point-of-care polymerase chain reaction (POC-PCR) testing for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition to suspect cases, the ED also regularly tested hospital employees. To reduce the number of samples, employee’s swab samples were pooled for testing. This study aimed to analyse the impact of POC-PCR on diagnostic samples’ processing times, evaluated the efficacy of the pooling method among hospital personnel, and determined percentage of false-negative rapid antigen tests (RATs) in comparison with POC-PCR. Materials and Methods: The study included ED patients, hospitalized patients, and hospital personnel. Patients underwent oropharyngeal and nasopharyngeal swabbing. Personnel were screened using the pooling method, combining up to five swabs per test tube. Real time PCR (RT-PCR) was modified to POC-PCR, with or without automated nucleic acid extraction. High-priority patients were tested using the Multiplex PCR QIAstat-Dx Respiratory SARS-CoV-2 Panel. Results: Before the POC-PCR laboratory was established, the median processing times from sample collection to PCR results were 74.29 and 8.35 hours, respectively. Following the establishment of the POC-PCR laboratory in 2021, the median further reduced to 3.25 hours in September 2021, 2.30 hours in September 2022, and eventually reached 1.30 hours in September 2023. Additionally, out of the total 1608 RATs conducted over a 3-month period, 3.4% were false negatives. The pooling method allowed hospital staff samples to be analysed within 2.30 hours, or in the case of a positive pool, within 6 hours of each shift. Multiplex PCR for severe ED patients showed predominant SARS-CoV-2, followed by Rhinovirus/Enterovirus, Influenza, and other Coronaviruses. Conclusion: POC-PCR integration in the ED has significantly reduced time to diagnoses and proved the efficacy of the pooling method, easing the burden on ED and paving the way for further POC-PCR laboratory development.