Point of Care Patient Testing (POCT) — ONPS 2425/6 Assignment — Introduction of a new POCT device Essay Example

Lecturer

POCT Report

For most commonly ordered tests, point of care testing (POCT) provide rapid results. In actual facts, the provider is able to gain objective information at the site rather than waiting for samples to be sent to the lab for results (hygesen, Alpert & Jaffev). Since laboratory data forms the basis of medical decisions, POCT is one of the fastest growing areas of clinical lab testing. The emergency department require swift establishment of the diagnosis, immediate treatment where necessary and a decision on admission, transfer or home care (Loten, Attia, Hullick, Marley & McElduff)

Point of care testing in the emergency department

Through the introduction of creatinine testing in radiology, patient using the computed topography (CT) or magnetic resonance imaging (MRI) must have a recent creatinine and estimation of glomerular filtration rate in their medical records before any other agent can be given (Loten, Attia, Hullick, Marley & McElduff). POCT enables this test to be performed immediately and other radiologic studies continue without any delay. It is however worth noting that, this will cost a few more dollars than a central laboratory. POCT for cardiac markers is critical for emergency department length of stay. The electrocardiogram and blood cardiac markers should include troponin I and T for they are crucial in the diagnostic information and differential diagnosis (Loten, Attia, Hullick, Marley & McElduff)

Test of performance

This is the ability of a test to differentiate between a healthy and an unhealthy issue. Test performance in this case is the ability of a cardiac troponin POCT to accurately differentiate between a patient with positive Acute Coronary Syndrome (ACS from those with similar symptom but with a negative Acute Coronary Syndrome (Van Dyck et al). Cardiac troponin POCT is a screening test which means the sensitivity is of essence. For clinical outcome, cardiac troponin POCT decreases the risk of adverse cardiac related events or readmission rates are correlated to central lab testing for patient in the ED (Stengaard, Thorsted & Terkelsen).

Emergency Department process outcome

Turnaround time (TAT) — this is the time taken between taking the sample and the reporting of the results. POCT reduces the TAT compared to lab testing. It is recorded that, the central lab testing for cardiac troponin take at least 58 minutes compared to 15 minutes for POCT (Hart, Lindsel & Ryan)

Time to decision, time to disposition, time to treatment and time to transfer — the substantial improvement in turnaround time automatically improve these time outcome (Loten, Attia, Hullick, Marley & McElduff)

Length of stay — there is a reduction of time spent in the emergency department with troponin and creatinine POCT as compared to central lab methods (Perveen, Unwin & Shetty).

Service level analysis

  • POC should be under an accredited pathology service. At the same time there should be ED staff training for specimen collection techniques using POCT device.

  • There should be a mechanism to ensure that proper maintenance is achieved. Quality control and quality assurance, trouble shooting procedures for the POCT should be precise ( Gill & Shephard).

  • Accurate recording of results from tests performed POCT should be ensured. The transfer of the same information electronically should be appropriate and necessary security concerns addressed.

  • There should be clear information about the costs of testing and billing arrangements between the ED, the Laboratory and the hospital (Loten, Attia, Hullick, Marley & McElduff)

Conclusion

The implementation of POCT is essential in the hospital for it will make diverse improvements in the service delivery especially in the emergency department.

References

Gill, J.P., Shephard, M.D. » The Conduct of Quality Control and Quality Assurance Testing for PoCT Outsidethe Laboratory .» Clin Biochem Rev. 31(3) (2010): 85–8.

Hart, K. W., Lindsel,l C., Ryan, R. » A time-and-motion study of the processes required to obtain cardiac biomarker assays using central laboratory, near-patient testing, and bedside point of-care testing. .» Point Care. 11 (2012): 62-68.

hygesen, K., Alpert, J.S., Jaffev A.S. «Third universal definition of myocardial infarction.» Eur Heart J. 33(20) (2012 ): 2551-67.

Loten C, Attia J, Hullick C, Marley J, McElduff P. » Point of care troponin decreases time in the emergency department for patients with possible acute coronary syndrome: A randomised controlled trial. .» Emerg Med J. 27(3) (2010): 194–8.

Perveen, S., Unwin, D., Shetty, A.L. «Point of care D-dimer testing in the emergency department: a bioequivalence study.» Ann Lab Med.33: (2013): 34-38.

Stengaard, C., Thorsted, S. J, Terkelsen, C.,J. . «Prehospital point of care testing of biomarkers has diagnostic value in relation to acute myocardial infarction [in Danish]. .» Ugeskr Laeger. 175: 9 (2013): 186-18.

Van Dyck W, Vertes G, Palaniappan M, Gassull D, Jain P, Schulthess D,. » Acute coronary syndrome: what is the cost-effectiveness of prevention, point-of-care technology and telemonitoring? .» Health Policy and Technology.1(3) (2012 ): 173–7.