1997 OPEN FORUM Abstracts
Five Things I Learned This Year about Point-of-Care Testing
Catherine M. Foss, BS, RRT, RPET, Monday, December 8, 1997.
Instruments used for Point of Care Testing (POCT) are currently available, that allow RCP's and other allied health professionals to perform blood gas, electrolyte, metabolite and coagulation analysis at or near the patient's bedside. POCT is an application of these instruments, not a technology. As an institution considers the needs of a clinical area for lab testing, POCT may be one of the options. The five issues discussed here should be considered when POCT implementation is being evaluated.
1. Costs: a. Fixed and variable costs must be included in any evaluation b. POCT has higher costs per reportable analytes then a central lab or stat lab scenario in most cases c. Look at the big picture for POCT implementation Has length of stay been altered? Has cost per discharge been reduced? Has the number of medications and/or doses been decreased? Has medical staff time for interventions been decreased? Has the volume of testing utilization been altered? 2. Technical consideration: a. Pre-analytical errors must be considered especially when non-technical staff are performing tasks. b. Is the instrument affected by staff technique in analyzation, will results be altered? 3. Quality issues: a. Precision and accuracy of instrumentation must be addressed and validated. Vendor certification of failure rate must be provided in writing. b. Quality Control issues include liquid vials Vs electronic checks, and calibrations. c. Will TAT be affected, and at which component? 4. Regulatory Issues: a. CAP checklist will be discussed. JCAHO and CLIA issues will be considered. The NCCLS subcommittee on unit based instruments has been having sessions for over a year, their current status will be discussed. 5. WHO, WHERE, WHY, HOW? The testing requirements of each particular institution, and even specific clinical areas may be uniquely different, and must be defined by the following issues. a. Who is the customer, what are their specific analyte requirements? b. Where should the testing be done? c. Who will perform the sample analysis? d. How will data management be handled? e. Who will train, supervise and review results? f. Who will perform proficiency testing and quality control?
Objective criteria must be prepared in advance of implementation to assess the success of initial POCT trials. When considering the laboratory requirements for an institution, the needs of all the constituents must be considered. Laboratory personnel, Respiratory staff, Hospital administration, Physician and Nursing staff all must be included.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.