Point-of-care testing

Point-of-care testing (POCT), or bedside testing is defined as medical diagnostic testing at or near the point of care—that is, at the time and place of patient care.[1] This contrasts with the historical pattern in which testing was wholly or mostly confined to the medical laboratory, which entailed sending off specimens away from the point of care and then waiting hours or days to learn the results, during which time care must continue without the desired information.

Point-of-care tests are simple medical tests that can be performed at the bedside. In many cases the simplicity was not achievable until technology developed not only to make a test possible at all but then also to mask its complexity. For example, various kinds of urine test strips have been available for decades, but portable ultrasonography did not reach the stage of being advanced, affordable, and widespread until the 2000s and 2010s. Today portable US is often viewed as a "simple" test, but there was nothing simple about it before the technology was available. Similarly, pulse oximetry can test arterial oxygen saturation in a quick, simple, noninvasive, affordable way today, but in earlier eras this required an intraarterial needle puncture and a laboratory test; and rapid diagnostic tests such as malaria antigen detection tests rely on a state of the art in immunology that did not exist until recent decades. Thus, over decades, testing continues to move toward the point of care more than it formerly had been. A recent survey in five countries (Australia, Belgium, the Netherlands, the UK and the US) indicates that general practitioners / family doctors would like to use more POCTs. [2]

The driving notion behind POCT is to bring the test conveniently and immediately to the patient. This increases the likelihood that the patient, physician, and care team will receive the results quicker, which allows for immediate clinical management decisions to be made. POCT includes: blood glucose testing, blood gas and electrolytes analysis, rapid coagulation testing (PT/INR, Alere, Microvisk Ltd), rapid cardiac markers diagnostics (TRIAGE, Alere), drugs of abuse screening, urine strips testing, pregnancy testing, fecal occult blood analysis, food pathogens screening, hemoglobin diagnostics (HemoCue), infectious disease testing and cholesterol screening.[3]

POCT is often accomplished through the use of transportable, portable, and handheld instruments (e.g., blood glucose meter, nerve conduction study device) and test kits (e.g., CRP, HBA1C, Homocystein, HIV salivary assay, etc.). Small bench analyzers or fixed equipment can also be used when a handheld device is not available—the goal is to collect the specimen and obtain the results in a very short period of time at or near the location of the patient so that the treatment plan can be adjusted as necessary before the patient leaves.[4] Cheaper, faster, and smarter POCT devices have increased the use of POCT approaches by making it cost-effective for many diseases, such as diabetes, carpal tunnel syndrome (CTS)[5] and acute coronary syndrome.

Technology

Many point-of-care test systems are realized as easy-to-use membrane-based test strips, often enclosed by a plastic test cassette. This concept often is realized in test systems for detecting pathogens. Very recently such test systems for rheumatology diagnostics have been developed, too.[6] These tests require only a single drop of whole blood, urine or saliva, and they can be performed and interpreted by any general physician within minutes.

Benefits

Major benefits are obtained when the output of a POCT device is made available immediately within an electronic medical record. Results can be shared instantaneously with all members of the medical team through the software interface enhancing communication by decreasing turn around time (TAT). A reduction in morbidity and mortality has been associated with goal-directed therapy (GDT) techniques when used in conjunction with POCT and the electronic medical record.[7]

POCT has become established worldwide[8] and finds vital roles in public health.[9] Many monographs in the Thai[10][11] and Indonesian [12] languages emphasize POCT as the normal standard of care in disaster situation.

Potential operational benefits of POCT: more rapid decision making and triage, reduce operating times, reduce high-dependency, postoperative care time, reduce emergency room time, reduce number of outpatient clinic visits, reduce number of hospital beds required, ensure optimal use of professional time.

See also

References

  1. ↑ Kost, Gerald J. (2002). "1. Goals, guidelines and principles for point-of-care testing". Principles & practice of point-of-care testing. Hagerstwon, MD: Lippincott Williams & Wilkins. pp. 3–12. ISBN 0-7817-3156-9.
  2. ↑ Howick, J; Jones, C; Price, CP; Plüddemann, A; Heneghan, C; Berger, MY; Buntinx, F; Hickner, J; Pace, W; Badrick, T; Van den Bruel, A; Laurence, C; van Weert, HC; van Severen, E; Parrella, A; Thompson, M (8 August 2014). "Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA". BMJ Open. e005611. doi:10.1136/bmjopen-2014-005611.
  3. ↑ "Point of Care Diagnostic Testing World Markets - TriMark Publications".
  4. ↑ "College of American Pathologists POCT toolkit".
  5. ↑ Tolonen U, et al. (2007). "A handheld nerve conduction measuring device in carpal tunnel syndrome". Acta Neurol Scand. 115 (6): 390–7. doi:10.1111/j.1600-0404.2007.00799.x. PMID 17511847.
  6. ↑ Egerer K, Feist E, Burmester GR (March 2009). "The serological diagnosis of rheumatoid arthritis: antibodies to citrullinated antigens". Dtsch Arztebl Int 106 (10): 159–63. doi:10.3238/arztebl.2009.0159. PMC: 2695367. PMID 19578391.
  7. ↑ Rossi AF, Khan D (June 2004). "Point of care testing: improving pediatric outcomes". Clin. Biochem. 37 (6): 456–61. doi:10.1016/j.clinbiochem.2004.04.004. PMID 15183294.
  8. ↑ Tran NK, Kost GJ (2006). "Worldwide point-of-care testing: compendiums of POCT for mobile, emergency, critical, and primary care and of infectious diseases tests". Point of Care: the Journal of Near-Patient Testing & Technology 5: 84–92. doi:10.1097/00134384-200606000-00010.
  9. ↑ "Special Edition in Public Health". Point of Care: the Journal of Near-Patient Testing & Technology. December 2006.
  10. ↑ Kost, G.J. (2006). "1. Overview of point-of-care testing: Goals, guidelines, and principles". In Charuruks N. Point of Care Testing for Thailand (in Thai). Bangkok. pp. 1–28.
  11. ↑ Kost, G.J. (2006). "10. Point-of-care testing in province hospitals and primary care units (PCUs): Optimizing critical care and disaster response". In Charuruks N. Point of Care Testing for Thailand (in Thai). Bangkok. pp. 159–77.
  12. ↑ Kost GJ, Tran NK, Tuntideelert M, Kulrattanamaneeporn S, Peungposop N (October 2006). "Katrina, the tsunami, and point-of-care testing: optimizing rapid response diagnosis in disasters". Am. J. Clin. Pathol. 126 (4): 513–20. doi:10.1309/NWU5E6T0L4PFCBD9. PMID 16938656.
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