Optimizing Point-of-Care (POCT) Glucose Testing Frequency in the Emergency Department (ED)

Year Submitted: 2025
Published Date: 25 March 2025

Tags: Care Continuum, Acute Care, Care Process ＆ Redesign, Productivity, Cost Saving, Time Saving, Value Based Care, Safe Care

About this Content

Aims

We aim to reduce the average no. of POCT glucose test performed for DM patients by at least 15% from 4.6 to 3.9 by December 2025. Our goal is to optimize the frequency of POCT glucose testing for diabetic patients in the ED without compromising patient safety or the quality of care. This change aims to improve nursing time efficiency and cost-effectiveness while maintaining appropriate glycaemic control for our diabetic patients.

Background

The Emergency Department currently performs hourly point-of-care testing (POCT) glucose tests for diabetic patients. This practice, while intended to ensure close monitoring of blood glucose levels, contributes to: reduced nursing efficiency as frequent testing takes time away from other patient care activities, patient discomfort from repeated finger pricks, and unnecessary costs due to overutilization of POCT glucose strips and associated supplies.

Methods

Root-cause analysis using fishbone diagram, PDSA cycles with three interventions: establishment of new Appropriate Diabetes Care Protocol with comprehensive guide for managing hypoglycemia and hyperglycemia, implementation of standardized POCT glucose testing frequencies for hyperglycemia patients (glucose 20 mmol/L tested once within 2-4 hour period before disposition), and refined protocol for hypoglycemia patients allowing discontinuation of hourly monitoring when patient is eating well and BSL 10 mmol/L for 2 consecutive readings. Protocol review and agreement with Endocrine, ED senior doctors and Nursing leaders.

Results

Average number of POCT glucose tests per DM patient reduced by 20% from 4.6 to 3.7 (exceeded target of 15% reduction)
Average monthly number of POCT glucose tests for DM patients reduced by 24% from 395 to 300
Median Length-of-Stay reduced by 2 minutes from 302 to 300 minutes
Saved approximately 16 hours per month of nursing time (~10 minutes per test)
95 fewer POCT glucose tests per month, reducing patient discomfort
Cost reduction through decreased utilization of test strips and extended machine lifespan
Maintained quality of care with slight improvement in patient flow

Lessons Learnt

Scalability: Methodologies and strategies developed can be readily adapted to address other unnecessary investigations or procedures within ED. Patient-centered care and operational efficiency can be mutually reinforcing when thoughtfully aligned. By reducing unnecessary interventions, we can enhance patient comfort and satisfaction by allowing more time for essential care activities. Interdisciplinary collaboration is critical when implementing new care pathways. Effective cooperation among stakeholders is instrumental in achieving desired outcomes. It is necessary to engage all relevant stakeholders early in planning process and maintain clear communication channels throughout project lifecycle.

Keywords

POCT glucose testing, emergency department, diabetes, nursing efficiency, cost reduction, patient safety

Innovators' Details

Connect with this contributor!

Dr Jacqueline Situ - situ_wangmin@nuhs.edu.sg

Project Attachment

Optimizing POCT Glucose Testing Frequency in the ED.pdf