Point of Care Testing
Point of Care Testing (POCT) is defined as any analytical test performed for a patient by a health care professional outside the conventional central laboratory. It is now an established part of clinical practice. Although the analytical aspects of POCT may be similar to those of central lab tests, shifting the testing from central lab to patient bedside presents a unique set of challenges. As a consequence, many issues related to regulatory compliance, data integration and pre analytical processes differ from central lab.
The POCT menu includes both waived, PPM and moderately complex tests performed by various levels of hospital personnel, includes physicians, anesthesiologists, perfusionists, RNs, respiratory therapists, phlebotomists and patient care assistants. The areas that perform waived testing are accredidated by Joint Commission on the Accreditation of Hospitals (JCAHO), PPM and moderate complex testing by College of American Pathologists (CAP) and are included under the laboratory's CLIA certificate. The total number of POCT tests performed annually is approximately 900,000. The waived testing includes whole blood glucose (Life Scan), stool for occult blood (Sure-Vue), gastric aspirates and vomit for pH and occult blood (Gastroccult), urine dipsticks (Bayer), urine pregnancy (OSOM), hemoglobin (HemoCue), rapid strep (Signify A), H.pylori (Pyloritek) and hemoglobin A1C (DCA2000). Whole blood glucose is the most utilized waived test with a total volume of 500,000 annually. The system has 109 Sure Step Flexx glucometers, 62 download locations spread over 45 nursing stations. The database supports greater than 2000 certified operators and all patient and QC results. The RALs Plus IMS screens over 1000 patient test results daily and sorts results according to the customization profiles established by the POCT division. The POCT division routinely monitors various QA indicators for the above-waived tests for successful performance of QC and patient reporting. These QA indicators include documentation of patient identification, patient test results, internal and external QC, lot number and expiration date of testing kits, operator identification and critical value confirmation. POCT division generates a monthly report for each test performed on individual nursing units to the respective nursing manager.
The PPM tests include U\urine sediments, vaginal wet preps, KOH preparations and fern tests. These tests are performed by physicians in the varying clinics through out the institution. The POCT division monitors the physician performance by CAP surveys, as they are exempt from training and annual competency.
The moderately complex tests include blood gases (I-STAT), electrolytes, glucose, BUN, creatinine, ionized calcium, hematocrit (I-STAT), ACT, PT-INR testing (I-STAT), BNP (Bio-site) and fetal scalp pH (Bayer). Currently we have I-STAT devices in all our 8 ICU's, 2 OR's and phlebotomy dept. at University and Memorial Campuses. All I-STAT devices are networked to the POCT office and interfaced to our LIS system. The POCT division monitors QC and patient data on a daily basis and are able to use system software to customize analyzers to suite specific nursing locations. All moderately complex testing is billed through our LIS system.
We look forward to great challenges in the future by continuing to expand and introduce new POCT technologies. These challenges provide great opportunity for both patients and health care system by providing physicians with superior diagnostic information at the time of visit and revenue enhancement by building billing mechanisms for all POCT.