Implementation of a Point-of-Care Satellite Laboratory (Kiosk) in the Emergency Department of an Academic Medical Center

In 2002, the Massachusetts General Hospital Clinical Pathology Division established a satellite laboratory staffed by laboratory-based medical technologists in our emergency department (ED "Kiosk") to perform a limited menu of rapid point-of-care tests. The initial menu included whole-blood cardiac markers, urine dipstick testing, urine pregnancy testing, and whole-blood glucose offered on the day shift only 5 d/wk. Implementation of these rapid tests resulted in an 87% decrease in turnaround time and was associated with a decrease in ED length of stay of 41 minutes for each patient tested. Since 2002, the menu and operations of the ED Kiosk have continued to evolve including the addition of new tests to the menu (rapid influenza, rapid RSV, rapid Strep A, urine drugs-of-abuse, and whole-blood d-dimer) and expansion of the hours of operation to 7 days, 24 h/d. Some of the new tests were shown to decrease ED length of stay (urine drugs-of-abuse testing, rapid d-dimer), whereas others were implemented to permit rapid diagnosis and triage of patients presenting to the ED. In this article, we describe our experiences with the operation of the ED Kiosk during an 8-year period.