Point-of-care Laboratory Testing Research Articles

Concern regarding point of care laboratory testing in neonates

No abstract available

Point-of-Care Laboratory Data Collection During Critical Care Transport

ObjectiveCritical care transport involves a high level of intensive clinical care in a resource-limited environment. These patients require multiple assessments guiding specialty treatments, including blood product administration, intravenous electrolyte replacement, ventilator management, and extracorporeal membrane oxygenation. This study aims to measure the usage of point-of-care (POC) laboratory data during critical care transport. MethodsData were collected via electronic medical record review over 1 year of use in a hospital-based critical care rotor wing, fixed wing, and ground critical care transport team in the Southeastern United States. ResultsOne hundred twenty POC tests were performed during 1,075 critical care transports over the 1-year period (8.9%). Patient transportations involved 35 extracorporeal membrane oxygenation, 21 medical, 17 cardiac, 13 neonatal, 11 respiratory failure, 8 gastrointestinal bleeding, 6 neurologic, 5 pediatrics, 3 trauma, and 1 organ donor. Seventy-eight POC laboratory tests (65%) required intervention, including ventilator changes (39.7%), electrolyte replacement (35.8%), blood products (7.6%), and other (12.8%). The remaining 42 (35%) POC laboratory tests confirmed no intervention was necessary (n = 35) and that ongoing treatments were effective (n = 7). ConclusionPOC laboratory testing performed during critical care transport guides providers in performing essential emergent interventions in a timelier manner that may benefit critically ill patients.

Abstract 10: Use of Point of Care Laboratory Testing During Critical Care Interfacility Transport

Introduction: Laboratory data is used to drive more than 70% of medical care decisions.1 Point of Care laboratory Testing (POCT) is one of the fastest growing areas of laboratory testing, as it has shown to reduce both time from first contact to intervention as well as length of stay within emergency departments.2,3 To date there is limited literature describing the use of POCT in critical care transport4 though its reliability and cost-effectiveness have been previously studied.5 This study aims to describe the use of POCT in critical care transport using the EPOC® blood analyzer (Alere, Inc), a CLIA-moderate complexity testing system. AirLink/VitaLink Critical Care Transport is accredited by the College of American Pathology to perform moderate complexity POCT as an independent laboratory.

Patient Care Alterations Following Point of Care Lab Testing During Critical Care Transport

Introduction: Laboratory data is used to drive over 70% of medical care decisions.1 Point of Care laboratory Testing (POCT) is one of the fastest growing areas of laboratory testing as it has shown to reduce both time from first contact to intervention as well as length of stay within emergency departments.2,3 To date there is limited literature describing the changes in patient care that occur during interfacility transport following POCT.4 However POCT has been previously shown to change patient care in the emergency department and intensive care unit settings in a more timely manner.5,6 No study to date has identified the frequency for which POCT labs result in patient care changes. This study aims to describe the patient care alterations that occur following POCT in critical care transport using the EPOC® blood analyzer (Alere, Inc), a CLIA-moderate complexity testing system. AirLink/VitaLink Critical Care Transport is accredited by the College of American Pathology to perform moderate complexity POCT as an independent laboratory.

Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.

Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7–25.6) and 16.7 (16.3–17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.

Implementation of point-of-care testing in an ambulatory practice of an academic medical center.

Point-of-care laboratory testing (POCT) offers reduced turnaround time and may promote improved operational efficiency. Few studies have been reported that document improvements from implementing POCT in primary care. We measured metrics of practice efficiency in a primary care practice before and after implementation of POCT, including the total number of tests ordered, letters and phone calls to patients, and revisits due to abnormal test results. We performed a cost and revenue analysis. Following implementation of POCT, there was a 21% decrease in tests ordered per patient (P < .0001); a decrease in follow-up phone calls and letters by 89% and 85%, respectively (P < .0001 and P < .0001); and a 61% decrease in patient revisits (P = .0002). Estimated testing revenues exceeded expenses by $6.62 per patient, and potential cost savings from improved efficiency were $24.64 per patient. POCT can significantly improve clinical operations with cost reductions through improved practice efficiency.

Patient Satisfaction With Point-of-Care Laboratory Testing: Report of a Quality Improvement Program in an Ambulatory Practice of an Academic Medical Center

Background: Point-of-care laboratory testing (POCT) offers reduced turnaround time and may facilitate medical decision-making and improve clinical operations. However, there is very little published data concerning the impact of POCT …

Utility of point-of-care testing in ED triage

BackgroundTriage systems are commonly used in emergency departments (ED) to prioritize patients. Laboratory testing is not typically used to help risk-stratify patients at triage. ObjectivesWe studied the utility of point-of-care (POC) testing at triage in ED patients with high-risk complaints. MethodsWe conducted a prospective observational study on a convenience sample of ED patients at an urban academic hospital with 60,000 annual visits. Patients who were triaged to the waiting area with any of the following criteria were approached for enrollment: (1) chest pain or shortness of breath in patients older than 40 years, (2) possible infection in the presence of two or more systemic inflammatory response system criteria in patients older than 18 years, and (3) patients >65 years with non-traumatic complaints. A total of 300 subjects were enrolled. All enrolled patients received POC testing that included a combination of Chem8+, hemoglobin, troponin, B-type natriuretic peptide, and lactate. The triage nurse completed a survey after receiving the results. ResultsPOC results was reported to be helpful in 56% of patients, changed the triage level in 15% of patients and led to 6% of patients being brought back for rapid physician evaluation. Overall, 50% of patients had one or more abnormal POC laboratory tests. There was no relationship between ED census and the likelihood of being helpful, changing the triage level, changing management, or bringing patients back any faster. ConclusionPOC testing at triage is a helpful adjunct in triage of patients with high-risk ED complaints.

Transfusion dependency of cardiac surgery--update 2006.

In developed countries perioperative blood transfusion requirements for red blood cell concentrates (RBC), platelet concentrates (PC), fresh frozen plasma (FFP) and stable plasma derivatives have now levelled off with more patients requiring less or no products whilst fewer patients need the larger proportion of donations. This text explores the reasons for such a development in patients undergoing cardiovascular surgery where the transfusion requirement has drastically declined in recent years. A reduced requirement of a mean of 2 RBCs is now the need per patient in most centers. Such a reduction is possible through various recent perioperative improvements: (i) thorough preoperative haematological checks in order to equip the patient for blood loss, surgical trauma and extracorporeal circulation (ECC) in which heparinized blood is pumped at high speed through an oxygenator, heat exchanger, reservoirs, tubings and connectors. (ii) Peroperative administration of inhibitors of fibrinolysis (aprotinin, epsilon-aminocaproic acid) reduce profuse haemorrhagic tendency. Successful attempts to minimise ECCs, including foamless aspiration of wound blood, refined surgical technology, tissue glue, and point-of-care laboratory testing (POCT) in the operating theatre all contribute to a reduced transfusion requirement. A substantial proportion of patients can now be operated on without ECC. New thrombelastography analysis allows for real-time monitoring of haemorrhagic/thrombogenic risk. Modern blood product quality contributes to limiting blood product usage. (iii) During the postoperative recovery phase, anaemia can be corrected by i.v.iron and recombinant human erythropoietin. Such measures allow the transfusion trigger, based on haemoglobin concentration, to be set as low as 70 g/l in suitable patients.

Transfusion dependency of cardiac surgery--update 2006.

In developed countries perioperative blood transfusion requirements for red blood cell concentrates (RBC), platelet concentrates (PC), fresh frozen plasma (FFP) and stable plasma derivatives have now levelled off with more patients requiring less or no products whilst fewer patients need the larger proportion of donations. This text explores the reasons for such a development in patients undergoing cardiovascular surgery where the transfusion requirement has drastically declined in recent years. A reduced requirement of a mean of 2 RBCs is now the need per patient in most centers. Such a reduction is possible through various recent perioperative improvements: (i) thorough preoperative haematological checks in order to equip the patient for blood loss, surgical trauma and extracorporeal circulation (ECC) in which heparinized blood is pumped at high speed through an oxygenator, heat exchanger, reservoirs, tubings and connectors. (ii) Peroperative administration of inhibitors of fibrinolysis (aprotinin, epsilon-aminocaproic acid) reduce profuse haemorrhagic tendency. Successful attempts to minimise ECCs, including foamless aspiration of wound blood, refined surgical technology, tissue glue, and point-of-care laboratory testing (POCT) in the operating theatre all contribute to a reduced transfusion requirement. A substantial proportion of patients can now be operated on without ECC. New thrombelastography analysis allows for real-time monitoring of haemorrhagic/thrombogenic risk. Modern blood product quality contributes to limiting blood product usage. (iii) During the postoperative recovery phase, anaemia can be corrected by i.v.iron and recombinant human erythropoietin. Such measures allow the transfusion trigger, based on haemoglobin concentration, to be set as low as 70 g/l in suitable patients.

Value of point-of-care blood testing in emergent trauma management.

No prospective study demonstrates the value of point-of-care laboratory testing (POCT) in the management of major trauma. In a prospective, noninterventional, study of 200 major trauma patients, we evaluated the influence of a blood POCT profile (hemoglobin, Na+, K+, Cl-, blood urea nitrogen, glucose, pH, PCO2, PO2, HCO3-, base deficit, and lactate) on emergent diagnostic and therapeutic interventions. Physicians responded to a standardized set of questions on their diagnostic and therapeutic plans before and after the availability of POCT results. Management plan changes were deemed emergently appropriate, if they were influenced by the POCT results and, within the ensuing 30 minutes, the change in management was likely to reduce morbidity or conserve resources. For emergently appropriate plan changes, Na+, Cl-, K+, and blood urea nitrogen were never influential, whereas in each of 6.0% of cases (95% confidence interval [CI], 3.5%-10.2%) at least one of the remaining POCT parameters was influential. An emergently appropriate change was based on hemoglobin in 3.5% of cases (95% CI, 1.0%-6.1%), blood gas parameters in 3.0% of cases (95% CI, 0.64%-5.7%), lactate in 2.5% of cases (95% CI, 1.1%-5.7%), and glucose in 0.5% of cases (95% CI, 0.1%-2.8%). All of these cases involved blunt injury. Na+, Cl-, K+, and blood urea nitrogen levels do not influence the initial management of major trauma patients. In patients with severe blunt injury, hemoglobin, glucose, blood gas, and lactate measurements occasionally result in morbidity-reducing or resource-conserving management changes.