University Medical Center of Southern Nevada (UMC)
Practical Point of Care Testing
Deb Lacava
Point of Care Testing (POCT) has long been regarded as a useful tool for quick diagnosis and turnover in an Urgent Care settings. Although automation in clinical labs has resulted in faster turnaround times and lowered costs, certain situations require an almost instant result to obtain a clinical picture of a patient’s status.
POCT can accomplish this speed and need for testing. Patients can remain in their assigned bed and the technician can collect the sample and run the test within minutes, without leaving the patient’s room. Practitioners can treat patients faster on the spot, without the wait.
Some of the tests most commonly used in these scenarios include blood glucose, CBC, Flu/RSV, urinalysis, and pregnancy testing. There are two types of POCT testing, waived and nonwaived. Waived testing, such as glucose, can be performed by anyone who has been trained to perform the test because there is a low risk of error in testing and reporting an incorrect result.
Non-waived testing is subcategorized as moderate or high complexity, therefore requiring greater skill and training. Some states, such as Nevada and California, require operators to hold a POCT license in the state in order to perform non-waived testing.
Although automation in clinical labs has resulted in faster turnaround times and lowered costs, certain situations require an almost instant result to obtain a clinical picture of a patient’s status
Maintaining compliance with POCT is important. Facilities must ensure their devices are in good working order. Quality control is routinely performed and reviewed, operators are up to date on competencies and training. Inventory is monitored to ensure the use of valid reagents and the data each instrument is producing is compliant with written standards. Any deviation can create incorrect patient results, and cause accreditation issues for the facility. In addition, facilities located in states that require additional licensure to perform moderate to high complexity tests must maintain compliance and updated licensing of their staff.
POCT can be useful in some instances, but if rapid results can be processed and reported directly from a clinical lab, there is a question regarding onboarding POCT in a facility. It is more expensive than traditional lab testing and, in some cases, more than four times the cost. If the result is critical to the treatment of the patient, there may be a reason to take on the additional expense. Otherwise, it is more cost-effective to perform the test on routine instruments rather than at the bedside.
In some circumstances, such as a remote, rural site, POCT might be the only way to obtain fast results. However, in an academic medical center, samples might be better suited to send to the lab. There is also concern with sample integrity and operator ability that can cause poor outcomes in POCT results. Many times, samples run on POCT are later sent to the lab for confirmation, defeating the purpose of rapid bedside testing.
The bottom line is there are pros and cons associated with POCT that should be assessed individually by a facility prior to implementation. By taking all the items mentioned into consideration, point-of-care testing can be a logical, costeffective, and patient-centric solution to a facility’s testing needs.
