paramedics , pharmacists , or any combination of trained healthcare workers , as well as laboratory professionals .
Benefits of POCT Operational benefits of POCT may include rapid decision making and triage , as well as the assurance of optimal use of professional time . POCT sets the stage for rapid diagnosis in the physician ' s office , ambulance , home , the field , or in the hospital room . Clinicians become empowered to make decisions at the point-of-care and this can have significant positive impact on healthcare delivery and address some of the challenges of health disparities .
There are other potential benefits depending on the specific situation and testing :
✓ Less sample volume ( pediatric , neonatal , ICU venues )
✓ Decreased pre-analytic concerns related to processing of specimens ( i . e . clotting , centrifugation , preservation ) ✓ Optimized drug treatments ✓ Reduced post-op care time ✓ Reduced hospital admissions ✓ Reduced hospital stays
Challenges of POCT Although POCT provides rapid results and the opportunity for faster medical decisions , the risk of errors with POCT often raises concern over the reliability of test results . In contrast to the core lab , where errors occur most frequently in the pre- and post-analytic phases , POCT errors occur primarily in the analytic phase of testing . This can be related to a lack of understanding or training of nonlaboratory staff who are typically involved in POCT , or as a result of test
Point of Care Testing may be performed by nurses , MAs , EMTs , paramedics , pharmacists , or any combination of trained healthcare workers , as well as laboratory professionals .
limitations and misuse of POCT in extreme environmental conditions . While the laboratory offers a structured , controlled testing environment , testing conditions for POCT can vary tremendously . Additionally , the connectivity needed to get POCT results into the EHR fast enough to effect a change in patient care is challenging .
Management of POCT can also be challenging for these reasons as well :
✓ Required documentation of training , QC , QA , PT activities , as well as competency assessments . ✓ Error management ✓ IQCP requirements , if applied ✓ Calculating the Cost-benefit ratio . The cost-per-test may actually be higher for a POC test ( as compared to the same test in a centralized lab ), but if the total patient episode of care cost is reduced , this better meets the patient needs and improves patient outcomes while lowering overall costs .
For certain POC tests , other concerns may include :
✓ Only adequate for screening ; needs follow up with confirmatory testing
✓ May not be FDA approved for all uses that the similar test in the lab is approved for ( e . g ., PT / INR approved for Coumadin monitoring but not for diagnosis of other coagulation disorders )
✓ Less precise testing may result in the need for further testing
“ POCT sets the stage for rapid diagnosis in the physician ' s office , ambulance , home , the field , or in the hospital room ”
✓ Poor quality control and / or improperly trained workers can mean even less accurate tests
✓ Use in settings where the POC tests have not been properly validated ( e . g ., handheld glucose meters in intensive care units for patients on tight glycemic control )
Managing Your POCT : Ensuring Quality and Compliance
POCT Management Team
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Irwin Z . Rothenberg , MBA , MS , CLS ( ASCP )
Management of POCT can be challenging . Testing may include multiple sites , many different POCT devices / kits , and dozens of operators that have to be managed in order to assure quality . Interdisciplinary POC management teams that include the laboratory , physicians , and nurses , are considered as the most effective way to ensure the quality of work performed . They would be responsible for : ✓ Determining the test menu ✓ Selecting methodologies ✓ Establishing policies and procedures ✓ Confirming proper training and competency assessment
✓ Overseeing regulatory compliance ✓ Documenting corrective action where necessary
✓ Providing advisory assistance to the end users of POC technologies
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