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POINT-OF-CARE TESTING - 17/08/11

Doi : 10.1016/S0031-3955(05)70329-1 
Mariano R. Fiallos, MD a, Usama A. Hanhan, MD a, James P. Orlowski, MD a, b
a Division of Pediatrics, Department of Critical Care Medicine, University Community Hospital, Tampa (MRF, UAH, JPO) 
b Department of Pediatrics, Nova Southeastern University, Ft. Lauderdale; and Department of Pediatrics, Critical Care, and Medical Ethics, University of South Florida, Tampa, Florida (JPO) 

Riassunto

In the intensive care unit (ICU), rapid changes in a patient's condition often necessitate biochemical monitoring with diagnostic laboratory tests and an immediate response. The term point-of-care (POC) testing, also called near-patient testing or bedside testing, refers to the performance of diagnostic tests at or near the patient. Traditionally, these tests were performed in the central or stat laboratory. With POC testing, these tests are performed outside of the confines of the clinical laboratories of health care facilities.

Point-of-care testing is being used in different locations, including clinics, health departments, independent laboratories (usually large clinic facilities, not reference laboratories, health fairs, transport services, hospitals, and patients' homes. In hospitals, they primarily are performed in areas with the most urgent need for rapid diagnosis and therapy, such as emergency departments, surgical suites, critical care units, and certain outpatient areas.20

With rapid advances in technology, POC testing is a dynamic work in progress; the analyzers are becoming smaller, faster, and more user-friendly and have been demonstrated to achieve accuracy with increasingly smaller blood samples, aiding in blood conservation.20 Blood conservation through small blood samples is an added asset for neonatal and pediatric patients, especially in the ICU, where the patient's condition often requires multiple blood draws.

The staff at every hospital and every critical care unit must decide which bedside tests or cluster of tests are indicated for their given patient population. To determine this, other factors must be considered, including advantages and disadvantages, analysis of test accuracy, clinical impact, and cost–benefit ratio. The advantages and disadvantages of POC testing include:

Advantages
Rapid availability of data
Decreased turnaround time
Immediate or almost immediate decision making
Rapid response to critical values
Potential shortened length of stay
Emergency departments
Outpatient facilities
Sample handing by a single operator
Collection, analysis, and notification
Decreased preanalytic error
Blood sparing (conservation)
Test clustering
Convenience for patients and physicians
Easily portable
Decreased patient cost
User-friendly
Patient-friendly
Disadvantages
Limited menu of tests
Documentation
Notification systems
Data recording
Transcription: postanalytic error
Sample handling error
Performance failures
Analytic performance
Operator's competence
Unauthorized testing
Duplication of instruments or methods
Potential increased cost
Compliance with regulations
Licensing

Il testo completo di questo articolo è disponibile in PDF.

Mappa


 Address reprint requests to Mariano R. Fiallos, MD Division of Pediatrics Pediatric Critical Care Medicine University Community Hospital 3100 E Fletcher Avenue Tampa, FL 33613–4688 e-mail: mfiallos@pol.net


© 2001  W. B. Saunders Company. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 48 - N° 3

P. 589-600 - giugno 2001 Ritorno al numero
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