You are not feeling well and you visit your doctor. Soon after explaining your problem to her, she measures your temperature, your blood pressure, and your blood glucose levels.
Instead of collecting a blood sample into a tube and sending it to the laboratory for blood glucose levels, she just pricks your finger, tests your blood glucose concentration and within less than 15 seconds the result is there. That’s Point-of-Care Testing (POCT).
Point-of-Care Testing (POCT) is near-patient, bedside, or extra laboratory testing performed by the doctor or nurse caring for the patient. The clinician gets results quickly and makes diagnostic, treatment, and monitoring decisions as early as possible resulting in improved clinical and/or economic outcomes.
POCT can be performed at home (self testing), at a clinic or doctor’s surgery, in the emergency department, in hospital wards, in the operating room, at the site of an incident or in the ambulance.
It is done to rule in or rule out disease in primary care, for example, testing for D-dimer levels to rule in or rule out Deep Vein Thrombosis and Pulmonary Embolism. Doctors can rule in or rule out a diagnosis for Myocardial infarction (MI) in the emergence room by testing for Troponin. However, extra caution must be taken because some of the POCT devices are not as highly specific for Troponin T and/or Troponin I as laboratory methods.
In primary care, or in the operating room, POCT results can be used to decide on drug dosage, to assess efficacy, and to monitor compliance. The tests include blood glucose, parathyroid hormone (PTH), and HbA1c.
At home, POCT can be used for guidance, reassurance, and convenience purposes. The tests include International Normalised Ratio (INR), white blood cell count, Natriuretic peptide, and a pregnancy test.
Advantages of POCT:
POCT results are obtained immediately allowing clinical decisions to be made faster than if a specimen had been collected and sent to a central laboratory.
In addition to this, there are no cases of results not being obtained due to samples getting lost in transit, samples collected in wrong containers, and wrong labelling.
In labile analytes, for example, glucose and lactate, time-dependent changes caused by delays in sample transportation to the laboratory are minimised.
Furthermore, preanalytical errors such as inappropriate sampling, inappropriate preparation or packaging of samples, and misidentification of patients are reduced. This is mainly because POCT has a low number of steps necessary to produce a test result.
The doctor or nurse caring for the patient performs the test and gets a result. This minimises postanalytical errors caused by incorrect transmission of results.
In POCT, sample collection is very simple. In most cases it’s just a finger prick, for example, when testing for blood glucose levels, or INR.
Furthermore, most POCT machines are accurate, precise, highly sensitive, linear and specific, and they give the same results as laboratory methods.
Disadvantages of POCT:
Some doctors and nurses complain that POCT adds more workload to their short-staffed workforce. Others complain that there are too many POCT devices. Why not come up with only two or three devices that can do all the tests?
Although POCT produces results quickly, implementing clinical management decisions immediately after receiving POCT results can be dangerous to the patient if any of the results are in error.
POCT does not use error detection schemes like automatic delta checking. The devices do not test for lipemia, icterus, and hemolysis. This leads to failure to detect errors, thereby increasing the risk to the patient.
There are also potential errors due to a lack of expertise and quality control. Nowadays, some POCT devices can be set to lock themselves whenever internal quality control is due, and some of them do not need calibration. This helps to reduce errors.
Another disadvantage of POCT is that some devices are incompatible to local laboratory methods resulting in results obtained in POCT being different to laboratory ones by far.
Furthermore, some POCT tests are more expensive per test than the central clinical laboratory resulting in increased costs.
Moreover, POCT results may be inadequately stored leading to loss of them within a short period of time. However, these days some POCT devices can be connected to the hospital information system, and the results get stored in the computer servers in the same way as laboratory ones.
POCT is still a very young section of pathology which keeps growing every day. Advancement in technology, machinery, quality control, and training in POCT will soon wipe out all its disadvantages. However, there is a need for POCT sections and departments to be compliant with the International Organisation of Standardisation (ISO) standards.
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