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Chapter 23 : Management of Point-of-Care Testing

Author: Glen L. Hortin
Content Type: Reference
Publication Year: 2004

Category: Clinical Microbiology

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Abstract:

In this chapter, the management challenges of point-of-care testing (POCT) are categorized into organizational, operational, and technological issues, although some of the issues listed in reality overlap into more than one category. The chapter concentrates on aspects of the management of POCT that differ from other areas of the laboratory and that are controversial. One of the most critical operational challenges is deciding what sites will perform POCT and what menu of tests should be offered. The major source of demand for POCT has been from clinicians who desire rapid laboratory results for clinical decision making. There are a number of other complicating factors about cost analysis, the most important being that of weighing the indirect effects of POCT on the overall cost of patient care. The major argument against use of electronic simulators is that although they check performance of the electronic components of an analyzer, they do not check the performance of the reagents. Procedures that are performed by devices attached to patients such as those involved in the analysis of breath specimens were considered to represent physiological monitoring rather than laboratory testing.

Citation: Hortin G. 2004. Management of Point-of-Care Testing, p 404-416. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch23
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References

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1. Alves-Dunkerson, J. A.,, P. E. Hilsenrath,, G. A. Cress,, and J. A. Wildness. 2002. Cost analysis of a neonatal point-of-care monitor. Am. J. Clin. Pathol. 117: 809– 818.
2. Asimos, A.W.,, M. A. Gibbs,, J. A. Marx,, D. G. Jacobs,, R. J. Erwin,, J. Norton,, and M. Thomason. 2000. Value of point-of-care blood testing in emergent trauma management. J. Trauma 48: 1101– 1108.
3. Boone, D. J.,, J. W. Hay,, J. Aguanno,, T. Getzen,, and G. Hortin. 2002. Are the correct economic factors influencing point-of-care testing? Point of Care 1: 212– 221.
4. Chmielewski, S. A. 1995. Advances and strategies for glucose monitoring. Am. J. Clin. Pathol. 104(Suppl. 1): S59– S71.
5.College of American Pathologists. 2003. Point-of-Care Testing Checklist. Laboratory Accreditation Program. College of American Pathologists, Northfield, Ill.
6. DeCresce, R. P.,, D. L. Phillips,, and P. J. Howanitz. 1995. Financial justification of alternate site testing. Arch. Pathol. Lab. Med. 119: 898– 901.
7. Despotis, J.,, J. E. Grishaber,, and L. T. Goodnough. 1994. The effect of an intraoperative treatment algorithm on physicians’ transfusion practice in cardiac surgery. Transfusion 34: 290– 296.
8. Ehrmeyer, S. S.,, and R. H. Laessig. 1995. Regulatory requirements (CLIA ’88, JCAHO, CAP) for decentralized testing. Am. J. Clin. Pathol. 104(Suppl. 1): S40– S49.
9. Ehrmeyer, S. S.,, and R. H. Laessig. 2001. Electronic “quality control” (EQC): is it just for unit use devices. Clin. Chim. Acta 307: 95– 99.
10. Ehrmeyer, S. S.,, and R. H. Laessig. 2003. POCT 2003: testing environment, regulations, and technology. Adv. Admin. Lab. 12(4): 28– 38.
11. Felder, R. A.,, J. Savory,, K. S. Margrey,, J. W. Holman,, and J. C. Boyd. 1995. Development of a robotic near patient testing laboratory. Arch. Pathol. Lab.Med. 119: 948– 951.
12. Fineberg, S. E.,, R. M. Bergenstal,, R. M. Bernstein,, L. M. Laffel,, and S. L. Schwartz. 2001. Use of an automated device for alternative site blood glucose monitoring. Diabetes Care 24: 1217– 1220.
13. George, S.,, and R. A. Braithwaite. 2002. Use of on-site testing for drugs of abuse. Clin. Chem. 48: 1639– 1646.
14. Grieve, R.,, R. Beech,, J. Vincent,, and J. Mazurkiewicz. 1999. Near patient testing in diabetes clinics: appraising the costs and outcomes. Health Technol. Assess. 3: 1– 74.
15. Gruszecki, A. C.,, G. Hortin,, J. Lam,, D. Kahler,, D. Smith,, T. Daly,, C. A. Robinson,, and R. Hardy. 2003. Utilization, reliability, and clinical impact of point-of-care testing during critical care transport—6 years experience. Clin. Chem. 49:(6 Pt. 1): 1017– 1019.
16. Hortin, G. L. 1997. Managing the forgotten bedside test—occult blood testing. Adv. Admin. Lab. 6(7): 4– 6.
17. Hortin, G. 1998. Handbook of Bedside Glucose Testing. AACC Press, Washington, D.C.
18. Hortin, G. L. 2002. The pursuit of less painful glucose testing. Adv. Admin. Lab. 11(4): 10– 11.
19. Hortin, G. L.,, and A.B. Carter. 2002. Intraoperative parathyroid hormone testing: survey of testing program characteristics. Arch. Pathol. Lab.Med. 126: 104– 109.
20. Hughes, M. 2002. Market trends in point-of-care testing. Point of Care 1: 84– 94.
21. Hurst, J.,, K. Nickel,, and L. H. Hilbourne. 1998. Are physicians’ office laboratory results of comparable quality to those produced in other laboratory settings? JAMA 279: 468– 471.
22.IFCC Working Group on Selective Electrodes. 2001. IFCC recommendation on reporting results for blood glucose. Clin. Chim. Acta 307: 205– 209.
23. Irvin, G. L., III, and G. T. DeRiso. 1994. A new practical intraoperative parathyroid hormone assay. Am. J. Surg. 168: 466– 468.
24. Johnson, L. R.,, G. Koherty,, T. Lairmore,, J. F. Moley,, L. M. Brunt,, J. Koenig,, and M. G. Scott. 2001. Evaluation of the performance and clinical impact of rapid intraoperative parathyroid hormone assay in conjunction with preoperative imaging and concise parathyroidectomy. Clin. Chem. 47: 919– 925.
25. Jones, B. A.,, P. Bachner,, and P. J. Howanitz. 1993. Bedside glucose monitoring: a College of American Pathologists Q-Probes study of the program characteristics and performance in 605 institutions. Arch. Pathol. Lab.Med. 117: 1080– 1087.
26. Jones, B. A.,, and P. J. Howanitz. 1996. Bedside glucose monitoring quality control practices. A College of American Pathologists QProbes study of program quality control documentation, program characteristics, and accuracy performance in 544 institutions. Arch. Pathol. Lab.Med. 120: 339– 345.
27. Jungheim, K.,, and T. Koschinsky. 2001. Risky delay of hypoglycemia detection by glucose monitoring at the arm. Diabetes Care 24: 1303– 1304.
28. Keffer, J. H. 1995. Economic considerations of point-of-care testing. Am. J. Clin. Pathol. 104(Suppl 1): S107– S110.
29. Kilgore, M. L.,, S. J. Steindel,, and J. A. Smith. 1999. Continuous quality improvement for point-of-care testing using background monitoring of duplicate specimens. Arch. Pathol. Lab. Med. 123: 824– 828.
30. Kilgore, M. L.,, S. J. Steindel,, and J. A. Smith. 1999. Cost analysis for decision support: the case of comparing centralized versus distributed methods for blood gas testing. J. Healthcare Manag. 44: 207– 215.
31. Kost, G. J. 2001. Preventing medical errors in point-of-care testing: security, validation, performance, safeguards, and connectivity. Arch. Pathol. Lab.Med. 125: 1307– 1315.
32. Kost, G. J. 2002. Principles and Practice of Point-of-Care Testing. Lippincott, Philadelphia, Pa.
33. Kost, G. J.,, T. H. Nguyen,, and Z. Tang. 2000. Whole-blood glucose and lactate: trilayer biosensors, drug interferences, metabolism, and practice guidelines. Arch. Pathol. Lab.Med. 124: 1128– 1134.
34. Kuwa, K.,, T. Nakayama,, T. Hoshino,, and M. Tominaga. 2001. Relationships of glucose concentration in capillary whole blood, venous whole blood and venous plasma. Clin. Chim. Acta 307: 187– 192.
35. Laposata, M. 2001. Point-of-care coagulation testing: stepping gently forward. Clin. Chem. 47: 801– 802.
36. Lee-Lewandrowski, E.,, M. Laposata,, K. Eschenbach,, C. Camooso,, D. M. Nathan,, J. E. Godine,, K. Hurxthal,, J. Goff,, and K. Lewandrowski. 1994. Utilization and cost analysis of bedside capillary glucose testing in a large teaching hospital: implications for managing point of care testing. Am. J. Med. 97: 222– 230.
37. Lehman, C. M.,, R. C. Blaylock,, D. P. Alexander,, and G. M. Rodgers. 2001. Discontinuation of the bleeding time test without detectable adverse clinical impact. Clin. Chem. 47: 1204– 1211.
38. Louie, R. F.,, Z. Tang,, and G. J. Kost. 2001. Emerging technologies for point-of-care testing. Adv. Admin. Lab. 10(9): 64– 68.
39. Main, R.,, J. Wright,, and F. L. Kiechle. 1994. Data management programs for bedside glucose testing. Lab.Med. 25: 784– 789.
40. McGarraugh, G. 2001. Response to Jungheim and Koschinsky: glucose monitoring at the arm. Diabetes Care 24: 1304– 1306.
41.NCCLS. 2001. Point-of-Care Connectivity; Approved Standard. NCCLS publication POCT1-A. NCCLS, Wayne, Pa.
42. Nichols, J. H. 2003. Point-of-Care Testing: Performance Improvement and Evidence-Based Outcomes. Marcel Dekker, New York, N.Y.
43. Paxton, A. 2001. Labs waver on whether to bill for POC tests. CAP Today 15(8): 1.
44. Price, C. P. 2001. Point of care testing. Br. Med. J. 322: 1285– 1288.
45. Price, C. P.,, and J. M. Hicks. 1999. Point-of-Care Testing. AACC Press, Washington, D.C.
46. Sokoll, L. J.,, H. Drew,, and R. Udelsman. 2000. Intraoperative parathyroid hormone analysis: a study of 200 consecutive cases. Clin. Chem. 46: 1662– 1668.
47. Steindel, S. J.,, S. Granade,, J. Lee,, G. Avery,, L. M. Clarke,, R.W. Jenny,, and K. M. LaBeau. 2002. Practice patterns of testing waived under the Clinical Laboratory Improvement Amendments. Arch. Pathol. Lab.Med. 126: 1471– 1479.
48. Steindel, S. J.,, and P. J. Howanitz. 2001. Physician satisfaction and emergency department laboratory test turnaround time. Arch. Pathol. Lab.Med. 125: 863– 871.
49. Stott, R. A.W.,, G. L. Hortin,, S. Miller,, C.H. Smith,, T. R. Wilhite,, and M. Landt. 1995. Analytical artifacts in the measurement of hematocrit by whole blood chemistry analyzers. Clin. Chem. 41: 306– 311.
50. Tamada, J. A.,, S. Garg,, L. Jovanovic,, K. R. Pitzer,, S. Fermi,, R. O. Potts, and the Cygnus Research Team. 1999. Noninvasive glucose monitoring: comprehensive clinical results. JAMA 282: 1839– 1844.
51. Weitgasser, R.,, B. Gappmayer,, and M. Pichler. 1999. Newer portable glucose meters—analytical improvement compared with previous generation devices? Clin. Chem. 45: 1821– 1825.
52. Whitley, R. J.,, P. J. Santrach,, and D. L. Phillips. 2001. Establishing a quality management system for unit-use testing based on NCCLS proposed guideline (EP18-P). Clin. Chim. Acta 307: 145– 149.
53. Wians, F. H.,, J. A. Balko,, R. M. Hsu,, W. Byrd,, and W. H. Snyder. 2000. Intraoperative vs. central laboratory PTH testing during parathyroid surgery. Lab.Med. 31: 616– 621.
54. Winkelman, J. W.,, and M. J. Tanasijevic. 2002. Noninvasive testing in the clinical laboratory. Clin. Lab.Med. 22: 547– 558.
55. Winkelman, J.W.,, D. R. Wybenga,, and M. J. Tanasijevic. 1994. The fiscal consequences of central vs. distributed testing of glucose. Clin. Chem. 40: 1628– 1630.

Tables

Management of Point-of-Care Testing
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Citation: Hortin G. 2004. Management of Point-of-Care Testing, p 404-416. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch23
/content/10.1128/9781555817695.chap23.tab23-1
Table 23.1

Management challenges of POCT

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10.1128/9781555817695/tab23-1.gif
Generic image for table
Table 23.1

Management challenges of POCT

Citation: Hortin G. 2004. Management of Point-of-Care Testing, p 404-416. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch23
/content/10.1128/9781555817695.chap23.tab23-2
Table 23.2

Goals of management of POCT

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10.1128/9781555817695/tab23-2.gif
Generic image for table
Table 23.2

Goals of management of POCT

Citation: Hortin G. 2004. Management of Point-of-Care Testing, p 404-416. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch23
/content/10.1128/9781555817695.chap23.tab23-3
Table 23.3

Common advantages and disadvantages of POCT versus central laboratory testing

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10.1128/9781555817695/tab23-3.gif
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Table 23.3

Common advantages and disadvantages of POCT versus central laboratory testing

Citation: Hortin G. 2004. Management of Point-of-Care Testing, p 404-416. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch23

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