Point-of-care testing

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Point-of-care testing (POCT), or bed-side testing is defined as medical testing at or near the site of patient care.[1] These are simple medical blood tests which can be performed at the bedside. Simple tests such as those found in medical examinations, urine test strips and even simple imaging such as with a portable ultrasound device. As well as regular observations such as ECG's, O
2
saturation
and heart rate.

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, infectious disease testing and cholesterol screening.[2]

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.[3] Cheaper, smaller, 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)[4] and acute coronary syndrome.

Technology[edit]

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.[5] 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[edit]

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.[6]

POCT has become established worldwide[7] and finds vital roles in public health.[8] Many monographs in the Thai[9][10] and Indonesian [11] languages emphasize POCT as the normal standard of care.

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.

References[edit]

  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. ^ "Point of Care Diagnostic Testing World Markets - TriMark Publications". 
  3. ^ "College of American Pathologists POCT toolkit". 
  4. ^ 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. 
  5. ^ 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. 
  6. ^ 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. 
  7. ^ 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. 
  8. ^ "Special Edition in Public Health". Point of Care: the Journal of Near-Patient Testing & Technology. December 2006. 
  9. ^ 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. 
  10. ^ 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. 
  11. ^ 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.