Blocked ward capacity and potential revenues.

Problem
Regarding transmissible viral diseases such as those caused by SARS-CoV-2 virus, one of the key challenges is isolation management until final diagnosis.
This study investigates the influence of SARS-CoV-2 point-of-care (POC) PCR on workflow and efficiency in an emergency department (ED) of a tertiary university hospital.
Method
An analysis of 17,875 ED patients receiving either SARS-CoV-2 POC PCR (rapid PCR, 11,686 patients) or conventional laboratory SARS-CoV-2 PCR (conventional PCR, 6,189 patients) was performed. The pathways for both groups were mapped and compared, and process times from admission to diagnosis were measured. Effects on resource management within the ED were quantified. Direct costs due to isolation, loss of capacities, and revenues were calculated for inpatients.
Results
The mean time from admission to result was 1.62 h with rapid PCR and 16.08 h with conventional PCR (p < 0.01), reducing the isolation time by 14.46 h. In the first 2 h after testing, test results were available for > 75% of the rapid PCR group and none of the conventional PCR group. Ninety percent of the results were available within 3 h for the rapid PCR and within 21 h for the conventional PCR group. For the conventional PCR group, an increase in direct costs of €35.74 and lost revenues of €421.06 for each inpatient case was detected.
Conclusion
Rapid PCR significantly reduces the time-to-results and time for isolation relative to conventional PCR. Although testing costs for rapid PCR are higher, it benefits workflow, reduces total costs, and frees up ward capacity.

问题提出
针对新型冠状病毒（SARS-CoV-2）引发的传染性病毒性疾病，明确最终诊断前的隔离管理是核心挑战之一。本研究针对某三级医学院附属急诊科（Emergency Department, ED），探讨新型冠状病毒（SARS-CoV-2）即时检验（Point-of-Care, POC）聚合酶链式反应（Polymerase Chain Reaction, PCR）对急诊工作流程与诊疗效率的影响。

研究方法
本研究纳入17875名急诊科患者，分别接受SARS-CoV-2 POC PCR（即快速PCR，共11686例）与常规实验室SARS-CoV-2 PCR（即常规PCR，共6189例）检测。对两组患者的诊疗路径进行梳理与对比，并测量从入院到获得诊断结果的流程时长；量化该检测方案对急诊科内部资源管理的影响；同时计算住院患者因隔离产生的直接成本、床位资源占用损失及相关收入损失。

研究结果
结果显示，快速PCR组从入院到获得检测结果的平均时长为1.62小时，常规PCR组则为16.08小时（p<0.01），较后者缩短隔离时长14.46小时。检测完成后的前2小时内，快速PCR组超75%的患者可获得检测结果，而常规PCR组无患者可及时获取结果；快速PCR组90%的患者可在3小时内获得结果，常规PCR组则需21小时。针对住院患者的分析显示，常规PCR组每例患者的直接成本增加35.74欧元，收入损失达421.06欧元。

研究结论
相较于常规PCR，快速PCR可显著缩短检测结果回报时长与隔离管控时长。尽管快速PCR的单次检测成本更高，但可优化急诊工作流程、降低总体成本并释放病房床位资源。