POCT At Bedside

According to the National Institutes of Health, point-of-care testing (POCT) holds the promise of timely treatment for patients, improved healthcare delivery and reduced disparities for hospitals. According to a fact sheet from the Bethesda, Md.-based agency, “The success of a potential shift from curative medicine to predictive, personalized and preemptive medicine could rely on portable diagnostic and monitoring devices for POC testing.”

Likewise, a 2010 article in “Deutsches Arzteblatt International” indicated that switching from conventional laboratory to POCT shortens the provider decision-making process. The article, entitled Point-of-Care Testing in Hospitals and Primary Care, defined testing at POC as “procedures of laboratory medicine in the immediate vicinity of the patient,” and predicted that “better medical outcomes and lower costs may ensue.”POCT

David Kaelber, MD, PhD, MPH, MS, FAAP, FACP, chief medical informatics officer at MetroHealth, said, “Assuming its reliable, easy-to-use POC technology allows the pace of healthcare to happen more quickly. In general, that’s good because it should lead to quicker interventions, which leads to decreased lengths of stay in the hospital and avoiding hospitalizations or emergency department visits.”

He added, “The reliability, accuracy and usability of these tests has to be at near 100%. Think about pregnancy tests. If 20% of pregnancy tests were wrong, it would be a total disaster.”

Point-of-Care Testing in Hospitals and Primary Care attributed miniaturization of lab instruments and procedures to an increased use of vicinity-based testing, noting that “results are immediately available at the patient’s bedside. This brings a time advantage, allowing results to inform urgent decisions about future diagnostic and therapeutic procedures.”

“If the POC costs less than non-POC test and is reliable, then that’s a no brainer. I’d be getting answers faster and cheaper. If my typical cholesterol test costs $50, but $30 at POC, that would save lots of money because I’m billing the payer less,” said Kaelber.

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Sarah Brown, PhD, DABCC, co-medical director, core laboratory at St. Louis Children’s Hospital, isn’t so sure. Citing connectivity issues, she said “POC technology is nearly there, but there are other components and they’re not there. POC is done at the bedside and often there is not a laboratory professional, which leaves a gap in interpretation. There are all sorts of tools to provide interpretations along with results, but we haven’t built that yet.”

Indeed, Point-of-Care Testing in Hospitals and Primary Care describes certain bedside applications, as “a useful complement to conventional laboratory testing. The future utilization of POC testing will depend, not only on technical advances, but also on developments in costs and reimbursement.”

Commenting on costs, Brown called POCT “expensive and rarely reimbursed.” She conmtinued, saying the “economics are definitely not there yet” for the wholesale swap of lab for bedside testing.

“If you want to measure blood gases at POC, it’s about $6 per test. Whereas you can do it in our core lab for about 30 cents,” said Brown, who noted that “boxed” POC tests create waste and add to the cost of care.

“A lot of this has to do with the technology in the cartridge. You load the specimen, put it in the instrument and, after it’s done, throw it away. In our core lab, our technology is built into our instruments. When we throw away stuff, we’re throwing away free agents, which is, essentially, water and electrolytes, not the technology,” she continued.

To deploy POC healthcare system-wide, Point-of-Care Testing in Hospitals and Primary Care advised a cost-benefit analysis “because the introduction is costly and requires a certain amount of organizational work especially for quality management. The potential medical and economic benefits should be assessed individually in each case,” it stated.

Kaelber said the decision to deploy POCT “depends on your healthcare delivery model and what you should be doing. Like many areas, this is rapidly growing. It’s not an area to put your head in the sand.” Kalber foresees the potential of bedside testing to raise all-important hospital survey scores.

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