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
Shorter care times require quicker testing
Today around half a million point-of-care tests are done
at Uppsala University Hospital. What do they cost, where do the
results end up, and how can their quality be assured? Questions
as well as answers were provided by Lars-Olof Hansson, head of the
ldepartment of clinical chemistry and pharmacology at the hospital.
The main reason for using POCT is to lower the hospital’s
total cost per patient. This is done by reducing the TAT (= turn
around time) for the patient and in the laboratory, by improving
analytical quality and by faster diagnostics and correct treatment.
The requirements for traceability have also increased: we have to
answer the questions about what, how, on whom, by whom, when
– and archive the replies.
Optically or electronically readable marking with barcoded systems
of patients identity are required to ensure that POCT results are
linked to the right patient and the right time. It is extremely
important that this also applies to the staff who take the samples.
The only effective way of reducing TAT is to minimise the number
of “handovers” of samples and test results by the testing
being done at the point of care. Examples of handovers: referral,
taking of sample, transport, centrifuging, recording, analysis,
report printing and delivery. As a result, a routine analysis can
take between two and 24 hours, while a POCT analysis only takes
between 5 and 20 minutes.
The basis for introducing POCT is a decision from the hospital
management and budget funds. Structuring work is then started, which
among other things comprises listing measurements and measuring
instruments, purchasing reagents, training and cost and efficiency
analysis. Quality assurance of POCT includes traceability, selection
of methods and instruments, regular checking of these, the preparation
of standard operating procedures (SOPs), certificate of competence
for staff as well as measurement and documentation of quality control
samples.
A steering group and a POCT team need to be appointed to manage
and co-ordinate the POCT activity. The steering group consists of
representatives of hospital management, clinical chemistry, accident
and emergency, intensive care, clinics and departments, and part
of the task is to create better communication between the laboratory
and clinical practice. It is therefore important to choose the right
individuals for both the steering group and the POCT team. It is
particularly important to find a POCT co-ordinator with social skills,
and it is the laboratory that is to direct the team.
A possible timetable:
Organisation and staff.
Listing of existing equipment and which point-of-care measurements
are already being carried out.
Training of staff (certificate of competence)
Co-ordination of purchasing equipment and reagents
Electronic linking of the point-of-care instruments to a QA server,
located in clinical chemistry.
Optically/electronically readable marking of patient identity
for quality assurance
Examples of samples analysed by POCT are: blood gases, blood Hb,
blood/plasma glucose, blood/plasma lactate, blood/plasma CRP, serum/plasma
electrolytes, serum/plasma creatinine, serum/plasma urea, serum/plasma
cardiac markers, blood white cell count, blood platelet count, blood/plasma
PK, blood/plasma APT time, blood/plasma ACT, plasma D-dimer, serum/plasma
ALAT, serum/plasma pancreatic amylase, serum/urinary hCG, urine
albumin, (/urine creatinine), rapid streptococcus group A test,
plasma mononucleosis test, urine test strip.
Healthcare must stop withholding information on test results.
Answering a patient's question on a test result with “it was
fine” is not good enough. In the future patients may perhaps
be able to read their records on the Internet. A web-based and barcoded
patient who looks after his own information...
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