Comparative Performance of POCT and Centralized Laboratory Testing

Comparative Performance of POCT and Centralized Laboratory Testing

Pressure on health-care providers in both the developed and developing countries has been intensifying even as technological development advances rapidly - Comparative Performance of POCT and Centralized Laboratory Testing introduction. A growing population, long life expectancy, and higher levels of health literacy have resulted in very high demand for health-care. Most states have been unable to supply sufficient resources to meet this increasing demand for health-care so that many health-care institutions now face challenges including staff shortages and overcrowding in hospitals. The challenges of overcrowding, difficulty in providing prompt laboratory services, and very high physician-patient ratio are most pronounced in urban areas (1). These challenges to the health-care industry have, just like among other industries, nudged researchers to develop new technologies and modify existing ones in order to meet the challenges. Point-of-Care Testing (POCT) technology has developed in response to these challenges and is growing rapidly and gaining increasing level of acceptance worldwide.

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Point-of-care testing entails analytical health tests which are done outside the laboratory environment, by laboratory professionals, non-laboratory staff as well as self-managing patients (2). Ehrmeyer & Laessig (3) define point-of-care testing as “patient specimens assayed at or near the patient with the assumption that test results will be available instantly or in a very short timeframe to assist caregivers with immediate diagnosis and/or clinical intervention.” By making it possible to perform necessary tests outside the centralized laboratory setting and with shorter turn-around time compared to centralized laboratory tests, point-of-care technologies are helping healthcare institutions to blunt the problem of overcrowding and are therefore a welcome blessing to the health-care industry. Primary health-care centres in the developed world are investing more heavily in point-of-care programmes, even as they continue to offer central laboratory services (4). It is however important that health-care institutions retain central laboratory services as their results are often more reliable.

Point-of-care testing versus centralized laboratory testing

Point-of-care testing offers advantages which make it more preferable to central laboratory testing. The most important of these advantages is the timeliness occasioned by the significantly shorter turn-around times (5). In emergency situations, health-care professionals appreciate that the length of time it takes to obtain test results is critical to the patient’s survival. The likelihood of survival and recovery diminishes as test turn-around time increases. Prior to the advent of point-of-care tests, physicians had to wait longer for test results before initiating medical procedures even when such delay jeopardized the patients’ chances of recovery. Point-of care test technology has made it possible for emergency services professionals to perform tests on patients as they transport the latter to hospital so that medical professionals at the hospital are able to take immediate action as soon as the evacuated patients reach the hospital (3). A shorter turn-around time leads to early prognosis, diagnosis and treatment (6). To the extent that these tests yield accurate and precise results, point-of-care testing is very beneficial to patients.

Point-of-care testing is also contributing generously to reduction of overcrowding in health-care institutions and promoting more efficient use of available health-care resources. Among many other tests, point-of-care technology allows health workers to test and measure patients’ levels of blood glucose, speed of blood clotting, blood cells counts, urine dipsticks, cold agglutinin test, and blood pressure with an acceptable level of precision and without necessarily taking the specimens for central laboratory tests (4). The fact that these tests are often done outside health-care institutions means that patients do not have to visit the institutions unless such visits are necessary. Patients are also trained to use portable point-of-care devices and do not need the help of a health-care worker whenever the need for a test arises. This means that health-care resources and staff, which are already under much pressure, concentrate on serious cases while capable patients enjoy the benefits of self-management. In the long-run, the frequency of hospital visits goes down and health-care resources are utilized more efficiently.

Additionally, point-of-care testing technology is associated with lower health-care costs. Some of the tests conducted on patients are costly. Frequent hospital visits mean that the patients, insurance companies or the government has to pay more for health-care. Delayed medical intervention may also lead to complications which are expensive to undo (7). These shortcomings are associated with centralized laboratory testing and have the effect of making health-care more expensive.

On the flipside, point-of-care test technology has been found to yield imprecise results which are less reliable than centralized laboratory test results. While the reliability and precision levels of point-of-care test devices has been improving consistently, numerous tests have shown that central laboratory results are more reliable and should be used whenever a critical medical procedure is to be performed on a patient (8).

One of the causes of the superiority of centralized laboratory tests is that laboratory professionals adhere to stringent professional standards. Professional and standardized training for laboratory staff minimizes the likelihood of laboratory staff making errors (9). There is no standardized training for users of point-of-care test technology. In the absence of strict and enforceable professional protocols, the risk of error rises significantly. Medical professionals, who are bound by the Hippocratic Oath, would rather delay intervention than endanger a patient’s life by taking the wrong action (7). In order to improve the reliability of point-of-care test results, relevant authorities need to develop a standardized curriculum based on which health workers using the technology should be trained.

Point-of-care testing devices give results which vary from the results of centralized laboratories. Unlike central laboratories whose results are easily compared with results from many other laboratories and are therefore reliable when deciding which results are normal and which are abnormal, point-of-care results are rarely compared with other results. Schimke (5) and Karon, Scott, Burritt & Santrach (6), Hawkins (10), and Boldt, Kumle, Suttner & Haisch (11) have established that the risk of error is higher in point-of-care tests than in centralized laboratory tests. When errors are suspected, health workers have to repeat the tests to reduce the risk of error. The need to repeat tests often negates the advantage of the short turn-around time (1). A step in the direction of improving the reliability of point-of-care tests should entail linking the tests with central laboratories. This action would ensure that the professionals performing the tests are bound by the rigorous professional standards which govern laboratory practice.

Bibliography

1. Lee-Lewandrowski E., Corboy D., Lewandrowski K., Sinclair J., McDermot S & Benzer TI.

Implementation of a Point-of-Care Satellite Laboratory in the Emergency Department of an Academic Medical Center. Archives of Pathology & Laboratory Medicine 2003; Vol. 127: pp 456-460

2. British Journal of Heamatology. Guidelines for Point-of-Care Testing: Haematology. British

             Journal of Heamatology 2008; 142: pp 904-915

3. Serio FD, Petronelli MA & Sammartino E. Laboratory Testing During Critical Care

Transport: Point-of-Care Testing in Air Ambulances. Clinical Chemistry & Laboratory Medicine 2010; 49(7): pp 955-9614

4. Haglund S., Transo B., Person L, Zafirova T & Grodzinsky E. Fast Laboratory Test Results

Alone Cannot Deliver the Benefits of Near Patient Testing: A Follow-up Study After 3 Years of Extended Laboratory Service at a Primary Health Care Centre. Journal of Evaluation in Clinical Practice 2009; 15: pp 227-233

5. Schimke I. Quality and Timeliness in Medical Laboratory Testing. Annal Bioanal Chem 2009;

 393: pp 1499-1504

6. Karon BS, Scott R., Burritt MF & Santrach PJ. Comparison of Lactate Values Between Point-

of-Care and Central Laboratory Analyzers. American Journal of Clinical Pathology 2007; 128: pp 169-171

7. Sickels J, Lafata JE & Ansell JE. Point-of-Care Testing in Oral Anticoagulant Monitoring. Dis

             Manage Health Outcomes 1999; 6(5): pp 291-301

8. Igbokwe AA. Comparison of Point of Care Testing (POCT) Methods and Central Laboratory

             Methods for Key Electrolytes. CAP Point of Care Testing Committee

9. Ehrmeyer SS & Laessig RH. Point-of-Care Testing, Medical Error, and Patient Safety: A 2007

             Assessment. Clinical Chemistry & Laboratory Medicine 2007; 45(6): pp 766-773

10. Hawkins RC. Comparison of Four Point-of-Care HbAIc Analytical Systems Against Central

             Laboratory Analysis. Singapore Medical Journal 2003; 44(1): pp 8-11

11. Boldt J., Kumle B., Suttner S. & Haisch G. Point-of-Care Testing of Lactate in the Intensive

Care Patient: Accuracy, Reliability, and Costs of Different Measurement Systems. Acta Anaesthesiologica Scandinavica 2001; 45: pp 194-199

 

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