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Healthcare in the 20th century put the impetus on specialized care away from the home in a range of expandingly more complex facilities, from physician offices and local hospitals through the gamut to tertiary care trauma centers, each with its own medical niche, expertise and specialized personnel and equipment. Late in the century, the movement shifted to the development and expansion of specialized centers with the majority of care placed in the home. Along with this newer thinking came a parallel shift in laboratory services from in-house hospital traditional laboratories to off-site and reference labs. This latter shift was based on technological innovation at the patients' needs. This distance of testing site to patient and caregiver leads to increased errors in result reporting and miscommunication. To have the availability of relatively immediate results on which to act in real time is essential to quality patient care. Point-of-Care testing (POCT) fits that niche.


The advancement of technology in healthcare is a continuous process that enhances diagnostic and treatment of our clientele. With the ever-increasing impetus for hospital discharge and subsequent homecare, the in-roads made with POCT equipment allows for the availability of the same intricate lab studies, such as blood gases and electrolyte analyses, as in the traditional hospital lab with accurate results. No longer is POCT simply a bedside glu-cometer used for trending purposes. Today's apparati can perform blood gas analysis on minimal blood samples. Many controvertial aspects arise with this expanding technique, both within the hospital and with homecare use.

Misconceptions abound with POCT use. The myths of a lack of accuracy, increased cost and unreliability all stem from early incarnations of POCT equipment. As with any new technique or equipment, the learning curve and technical augmentations improve the utility of the devices. Perpetuations of some of these concerns may also be attributed to revenue concerns of laboratory service facilities. Are these criticisms valid??

Today we need a lab service that can provide quick accurate results; one that fits the Institute of Medicine's 6 aims for healthcare. It must be safe, effective, evidence-based, patient centered, timely, efficient and equitable. Challenges to POCT rest with the need for quality assurance for the operation and maintenance of the sophisticated equipment by operators with limited technical skills. Redundant result and report capabilities for the patient record are also a must. Ensurance that the right patient gets the right test at the right time using the right sample and that the correct result is given to the appropriate caregiver who then makes the correct decision and takes the appropriate action thereon will lead to the best outcome. Once testing becomes optimized, the impetus can shift back to caregiver focus of attention on the patient. In other words, POCT can facilitate patient triage, optimal treatment options, convenience and value.

Blood gas analysis has been an important medical diagnostic and monitoring tool since its invention in 1957, with an explosive impact on medical care since the 1960's, considered, according to Dr. John Severinghaus, "the most important lab test for critically ill patients." Blood gas POCT can be performed on as little as 90 microlitres of blood with results in as little as 2 minutes. Blood gas testing with a POCT device can be performed using any sample type, be it arterial or venous blood from a syringe or capillary samples from a heelstick. When tested side by side with "traditional" blood gas analyzers, the accuracy of the results is unquestioned. Whereas end tidal C02 monitors are useful for trending but have intrinsic failings in certain circumstances, POCT of blood gases is a treatable, accurate result on which decisions can be made. The minimal blood volume necessary for accurate testing makes it especially useful in the neonatal population. Indeed, many out of hospital transports would be hard pressed to deliver as optimal care as possible without the POCT devices. Manipulation of therapies to stabilize the patient for transfer to tertiary facilities is greatly enhanced by accurate lab results and POCT further enables optimal care to be given. These minimal sample sizes also facilitate accuracy in that there is less interaction of the sample to ambient air and thusly less equilibration of the sample between the sampling and the testing. The larger the sample size, the more surface area affected by ambient air. Such immediate results lead to more timely intervention at less cost, both monetarily as well as physically as far as blood loss and sampling discomfort, than traditional testing. Many studies have shown the accuracy of POCT comparable to traditional laboratories with less preana-lytical errors and smaller specimen sizes. Labeling and sample mishandling are minimized. Minimal sample transport will minimize clotting, hemolysis and degradation of the sample.

The remaining drawbacks to POCT are the training of non-laboratorians in the function, handling and maintenance of the devices. Whereas sample testing is relatively easy to learn, some of the nuances of the devices themselves are less so. In addition, result reports appear on the device's screen and usually produce a temporary paper printout. These can easily be misplaced. An active interface with the patient record is needed.

Point of care testing is one of the most useful tools for clinicians. Quick, easy, portable and not exceptionally cost prohibitive, POCT is an excellent adjunct for bedside care and triage, especially useful when on out of hospital transport or when testing in a traditional lab is not feasible.

by David Kissin, BS, RRT
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Author:Kissin, David
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Article Type:Report
Geographic Code:1USA
Date:May 1, 2008
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