Point-of-care testing – a reality
to be dealt with
Report on a seminar on 19 November 2002
Arranged by the Swedish Association
of Health Professionals and the Swedish
Institute for Biomedical Laboratory Science (IBL)
back to report intro
Summing-up group discussions
Definitions of POCT
analysis is performed on the spot and the result is reported back
to the patient before the visit is completed
analysis performed outside the C laboratory by various professional
categories, depending on the situation
everything that is performed at the point of care, regardless
of category of staff
point-of-care testing – whole process from taking of sample
to use of results.
Medical responsibility
The medical responsibility is consultative, driving medical development
work. For POCT – the treating doctor/head of hospital laboratory.
Responsibility rests with the administrative head of the clinic
or department, and for a local laboratory it is the administrative
head of the central chemestry laboratory in the hospital.
Agreements have to regulate responsibility and clarify who does
what and what one is allowed to do, for example servicing and maintenance.
Laboratory medicine councils (LM councils) act as skills banks
in the decision-making process. “Right” people on the
LM councils, for instance assistance with procurements. However,
there are no LM councils in in-patient care.
The healthcare purchaser and provider do cost and efficiency assessment
jointly.
It is important to clarify where medical responsibility lies.
With the head of hospital laboratory, primary care doctor with laboratory
responsibility or medically responsible nurse ?
Who carries out POCT?
Analytical work and maintenance: Staff with certificate
of competence
Training: Laboratory medicine and POCT team in co-operation
with industry.
Quality follow-up: Quality manager.
Professional function: High consultative capability, breadth.
Daily maintenance: customer/user.
Preventive maintenance: industry.
Stocking of spare parts: laboratory medicine.
Cost and efficiency evaluation: co-operation between all
care units headed by medical care management. Documentation/sample
handling, electronic information flow, storage of data, automatic
signature of results, NPU codes.
Doctors and biomedical scientists co-operate for development of
POCT through training, quality, responsibility for medical equipment,
choice of instruments and tests.
Opportunities and consequences
Opportunities: job satisfaction and collaboration. Reduced
turn-around time, quicker diagnosis and treatment.
Threats: Fear and ignorance
Obstacles: Internal competition, ignorance, tradition,
fear, wrong attitude, availability of staff.
Organisation: With regard to POCT, some individual in a
central position should have overall responsibility for the quality
assurance/work which is also rooted “outside”. Within
the organisation, responsibility should be in the laboratory for
clinical chemistry.
Skills development/training: POCT team that co-ordinates
training/contacts with industry and department/user. Regular continuing
training to maintain skills, “driving licence”
Policy: Biomedical scientists should play a central role
in all analytical work, i.e:
- influence over purchasing
- encourage increased consultation
- be responsible for quality system
- inform about pre-analysis and biological variation
- be a mediator of knowledge
Consequences: New positive challenges for biomedical scientist
training to adapt to the needs of today and tomorrow by introducing
medical care knowledge, health and medical care organisation, finance
and education.
Possible new training courses for laboratory technicians and assistant
nurses, primary care training for biomedical scientists. There is
also a need for a structural change in laboratory medicine, and
the need for social skill is increasing.
The role of the biomedical scientist is in the process of changing
in the direction of consultant, instructor, informer and educationalist
– working interactively with clinics in a supporting and training
function. This change – which makes the biomedical scientist
more visible to heads of hospital laboratories – should be
viewed as a development and not as a threat. It means raising both
skill and status.
The increase in POCT is a fact that the profession must come to
terms with and respond to. But hospital-linked POCT needs an organisation,
and primary care laboratories should belong to laboratory medicine
so that skills can be put to better use. Today the situation in
the country varies.
The status of laboratory medicine must be raised, and the price
must be paid.
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