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Point of Care Testing
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Description of Point of Care Testing covering pros & cons as well as 8 analytes.
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Voorbeeld van de inhoud
Point-of-care testing (POCT)Urinalysis = example of POCT – been around for long time LECTURE FOR PRACTICAL
PCOT – name given to any test carried out at the point of care
Synonyms for POCT
• SIDE ROOM Testing – Dr takes sample from patient, then go in a side room for testing
• NEAR-PATIENT Testing i.e. at patient’s hospital bedside - rather than in laboratory – term used now
• PHYSICIAN OFFICE Testing – called this in America
- Doesn’t cover: temperature w/ thermometer/BP with BP machine– but can argue they are POCT
- Usually a test of biochemical analytes
SITES of POCT
• Hospital – Acute wards like ITU – Non-acute
• Primary care / Clinic
• Pharmacies
• Home
- Used in any context of having a RAPID RESULT enabling rapid action
Scope of PCOT Technology
1980s: Urinalysis, Blood glucose stick testing only available, one gas machine, all other testing = in lab
-> 2017: Handled devices + Mini benchtop analysers available at POC in hospital wards
1. Central Laboratory Testing – traditional one
Doctors office – Dr decides if test is needed, make a request, phlebotomist takes blood test/sample,
labelled sample is sent to reception + centrifuged + analyser to validate resutls, results sent either to Dr
or to further scientists for a follow up if BMS has any concerns
Turn around time can be an hour
2. Point of care testing – more recent much simpler
Health professional – Dr/Nurse decides if test is needed, take sample immediately, perform test, result
available almost immediately = immediate decision making – v fast turn around time
Down side – safeguards are removed – no long validation of result, no scientists overviewing the data
and if data is wrong Dr may be acting on wrong result– potentially dangerous
ADVANTAGES of POCT
• Portable – take meter to patient + can be taken home for out patients
• Rapid result = rapid decision making – most attractive in life threatening situations e.g. ICU or in A+E
where every second counts – use POC for rapid + non-rapid decision making e.g. for outpatients but if
rapid result isn’t needed then much harder to justify POC for a test
DISADVANTAGES of POCT
• High implementation cost to hospitals + cost of tests e.g. glucose test at POC more costly than lab
- But having result early might enable savings in future cases
• Potential for inappropriate use – over-usage – waste money
• Troubleshooting difficult – need contingency plan – Drs don’t have technical expertise
- Occurs in labs need to sterilise/relocate specimen
• ERRORS:
- Inaccuracy, imprecision wrong result -> wrong action of doctor = dangerous
- Incorrect storage
- Interferences - in POC usually analyse whole blood specimen so sample could be grossly
haemolysed/lipemic which can be oblivious
- Inadequate Quality Control – lab scientists are consciousness unlike Dr’s – tend to be in rush
can cause misleading results
- Inadequate training of using devices – mixed errors
, Safeguards
• Education
• Training
• Certification
• QC monitoring
• Operator alerts
• POCT team – train ppl. Check QA + devices are working
• Helpline
DRIVERS FOR EXPANSION OF POCT
• TECHNOLOGY – Devices – IT – Therapeutics – knock on effect for the need to test for a condition
– information technology (IT) allows results produced by devices to be monitored by central lab
- user access blocked if not doing QC
• COST pressure
– Efficiency savings
– Staff – largest cost factor, devices may reduce need for staff
• New working practices using POCT
– One-stop clinics – have this now, get initial assessment then many tests done on same day – don’t
need to worry about turn around time
– Home based delivery of care (therapeutics)
• Restructuring of NHS
– Laboratory networks – labs in different hospitals join to form single organisation/directory which saves
money – one lab for certain purpose
– Shift of workload to 1 degree/Primary care – GP
– efficiency/cost savings
• Changing nature of disease
– Ageing population – more age-related diseases like HD + Diabetes
– Lifestyle factors predispose to diseases
• Evidence driven – for new treatment, NICE guidelines produce requlations
• Changing expectations
– Patients want it
– Health professionals want it for rapid results
RANGE of POCT – all allow rapid result allows rapid decision making
ACUTE Tests
• Troponin • Renal profile • Coagulation testing
• Natriuretic peptides • Blood glucose • Pregnancy testing
• Haemoglobin • Blood gases • Substance misuse testing
• White cell count • Lactate
NON-ACUTE • Urinalysis • Glycated Hb (HbA1c ) • Urinary albumin: creatinine ratio • Lipids
3. URINALYSIS = POCT, around since 1950’s, useful test
Clinical utility
• Screening for various disorders by dip-sticking urine
– 1 o / primary care
– hospitals
– groups of diseases identified
- Most important are diabetes mellitus (DM) and kidney disease
Others: urinary tract infection (UTI), liver disease, haemolytic disease
- Early detection prevents morbidity later on
• Monitoring of treatment – by health professionals – self-monitoring
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