POCT and the Chemistry Lab: Part 1

April 2017 - Vol.6 No. 3 - Page #2

Q&A with Eugenio H. Zabaleta, PhD
OhioHealth Mansfield Hospital
Mansfield, Ohio

MedicalLab Management: How do you envision point-of-care testing (POCT) expanding in the near future and what disciplines of the core lab will be affected?

Dr. Zabaleta: I think there are several POC applications considered futuristic that are available already. As hospital labs face a growing emphasis on patient-centered care, there is pressure to deploy POCT throughout the facility. Invariably, when clinicians want to develop a protocol to improve patient satisfaction, increase clinical productivity, and improve patient safety, they ask whether there is a POCT application. In fact, there is no area of clinical practice involving laboratory diagnostics immune to these requests that I am aware of. POCT has come to be seen as a panacea of patient and physician satisfaction, and is being use to meet core measures and/or accreditation requirements. With this in mind, the addition of more POCT applications will not necessarily create or alleviate workloads in the lab, but their utility should be viewed as an opportunity for the laboratory to help empower providers to better serve our patients. A caveat being that any new POCT be correctly performed by trained personnel according to the complexity of the device and procedure.

MLM: What is involved in on boarding new POC tests for the lab and for practitioners?

Dr. Zabaleta: Whenever we are posed with questions regarding the availability of POCT in a certain clinical application, the following considerations should be discussed with the clinicians expected to use and benefit from the testing along with any appropriate administrative representatives:

  • Is the POCT going to consistently produce the right result? (The simple production of a result in no way ensures its accuracy.)
  • Does the POCT package insert support the intended clinical used?
  • What are the POCT device limitations?
  • Is the POC nature of the test more cost effective? (In some cases, a POC test is more expensive, but the overall cost of patient care is decreased due to expedited throughput or a decrease in adverse events.)
  • What are the potential consequences of an incorrect result and how this risk be mitigated?
  • How can we best characterize the test complexity and who will be allowed to perform it?

MLM: Currently, what are the most prominent POC tests utilized in your lab?

Dr. Zabaleta: As is probably common, the most prominent POCT devices utilized in my hospitals are glucose meters. However, we utilize multiple devices across the various hospital settings. As a multi-hospital and multi-care system, we employ POCT devices in the outpatient setting (eg, the Coumadin Clinic), emergency departments, operating rooms (especially in the open-heart program), intensive care units, surgical floors, the cancer infusion center, and other medical floors. POCT has become ubiquitous in most clinical hospital settings.

MLM: How are patients properly identified at the bedside?

Dr. Zabaleta: Most commonly, this is performed using positive patient identification devices that utilize some type of bar code scan of the patient’s armband. This scan interfaces with the patient’s electronic health record, which is critical to proper specimen collection, test ordering, and results posting. Many systems also document the clinician performing the test to bolster documentation and regulatory compliance.

MLM: Are there POC tests under evaluation for addition to your test menu?

Dr. Zabaleta: Yes there are. One example is related to our system’s development of freestanding emergency departments (FSED). The laboratory is currently evaluating and verifying several devices capable of performing a rather comprehensive test menu to meet the needs of the FSED.

Eugenio H. Zabaleta, PhD, is a clinical chemist at OhioHealth Mansfield Hospital in Mansfield, Ohio.

PART 2 of this series will focus on in-depth POCT applications.


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