Turnaround Time, Point-of-Care Testing, and a Future Role for the Clinical Pathologist

1993 ◽  
Vol 100 (2) ◽  
pp. 89-90 ◽  
Author(s):  
M. Desmond Burke
Keyword(s):  
Point Of Care ◽  
Turnaround Time ◽  
Point Of Care Testing ◽  
Future Role ◽  
Clinical Pathologist ◽  
Time Point

Requiem for the STAT Test: Automation and Point of Care Testing

2019 ◽  
Author(s):  
Gurmukh Singh ◽  
Natasha M Savage ◽  
Brandy Gunsolus ◽  
Kellie A Foss
Keyword(s):  
Point Of Care ◽  
Turnaround Time ◽  
Test Automation ◽  
Test Results ◽  
Point Of Care Testing ◽  
Tube System ◽  
Front End ◽  
Laboratory Test Results ◽  
Batch Testing ◽  
Pneumatic Tube System

Abstract Objective Quick turnaround of laboratory test results is needed for medical and administrative reasons. Historically, laboratory tests have been requested as routine or STAT. With a few exceptions, a total turnaround time of 90 minutes has been the usually acceptable turnaround time for STAT tests. Methods We implemented front-end automation and autoverification and eliminated batch testing for routine tests. We instituted on-site intraoperative testing for selected analytes and employed point of care (POC) testing judiciously. The pneumatic tube system for specimen transport was expanded. Results The in-laboratory turnaround time was reduced to 45 minutes for more than 90% of tests that could reasonably be ordered STAT. With rare exceptions, the laboratory no longer differentiates between routine and STAT testing. Having a single queue for all tests has improved the efficiency of the laboratory. Conclusion It has been recognized in manufacturing that batch processing and having multiple queues for products are inefficient. The same principles were applied to laboratory testing, which resulted in improvement in operational efficiency and elimination of STAT tests. We propose that the target for in-laboratory turnaround time for STAT tests, if not all tests, be 45 minutes or less for more than 90% of specimens.

Cost-effectiveness and Laboratory Turnaround Time using Expanded Point-of-Care Testing in the ICU

1999 ◽  
Vol 27 (Supplement) ◽  
pp. 115A ◽  
Author(s):  
Karen K. Giuliano ◽  
Thomas L. Higgins ◽  
Eileen Pysznik ◽  
William McGee ◽  
Sue Perkins ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Point Of Care ◽  
Turnaround Time ◽  
Point Of Care Testing

scholarly journals P216 Comparative Assessment C-reactive Protein Between a Point-of-Care Testing and Current Standard of Care (Immunonephelometric testing)

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S272-S273
Author(s):  
G Lorenzon ◽  
I Marsilio ◽  
D Maniero ◽  
A Rigo ◽  
B Barberio ◽  
...  
Keyword(s):  
Inflammatory Disease ◽  
Point Of Care ◽  
Standard Of Care ◽  
Turnaround Time ◽  
Blood Collection ◽  
Standard Laboratory ◽  
Point Of Care Testing ◽  
C Reactive Protein ◽  
Serum Samples ◽  
Reactive Protein

Abstract Background C-reactive protein (CRP) is widely used as a biomarker of inflammatory disease activity in hospitalized and non-hospitalized patients. In particular, CRP is commonly used in patients suspected to have an inflammatory bowel disease (IBD) or with a confirmed diagnosis of IBD diagnosis in order to drive the diagnostic approach, to monitor disease activity and to guide therapeutic adjustments. However, standard laboratory CRP testing (Immunonephelometric assays) present some drawbacks, including a turnaround time of 1–2 hours, and the need of specialized equipment, offices and laboratory personnel. Because of that, point-of care testing (POCT) was recently developed in order to provide results within 2 minutes from blood collection, enabling a rapid response to clinical condition. Aim To determine the degree of analytical correlation between a recently developed POCT (ProciseDx) using capillary whole blood and the comparative Immunonephelometric assay using serum samples. Methods From October to November 2020, consecutive patients hospitalized at Gastroenterology Unit, Padua University Hospital, aged > 18 years and with clinical evidence of active inflammatory disease or infection, who underwent to a standard of care CRP test (Dimension Vista – Siemens Healthineers) were included in the study (range 2.9–340 g/L). Within 1 hour from blood collection, in each patient, CRP quantitation from capillary whole blood collected by finger stick was performed using the ProciseDx CRP assay, with reportable range between 3.6–100 g/L. A Deming regression test was used to identify the correlation between the two methods. Results Eighty-three patients were enrolled (62.5% males with mean age ± SD: 60±18). The most common indications for hospitalisation were liver disease (34.9%), pancreatic disturbance (27.7%) and suspicious or recurrence of IBD (16.7%). ProciseDx POCT with finger prick samples required a turnaround time of 2±0.2 minutes, whereas serum samples analyzed in clinical laboratory with the reference method required a turnaround time of about 180±15 minutes (p<0.001). Overall, the correlation between the two tests was high (R squared of 0.899 (95% CI 0.916–0.968)). In particular, the correlation between the methods was even higher with CRP values between 0–100 g/L with R squared of 0.961 (95% CI 0.958–0.986). Conclusion The ProciseDx POCT allows a more rapid and comparable accuracy of CRP assessment in hospitalized patients as compared to the standard laboratory measurement. Moreover, the ProciseDx POCT does not require specialised personnel to be performed. The use of ProciseDx POCT may improve and accelerate the decision-making approach, further reducing the resources required for CRP assessment.

scholarly journals Point-of-care testing of coagulation in patients treated with edoxaban

2020 ◽  
Vol 50 (3) ◽  
pp. 632-639
Author(s):  
Florian Härtig ◽  
Ingvild Birschmann ◽  
Andreas Peter ◽  
Sebastian Hörber ◽  
Matthias Ebner ◽  
...  
Keyword(s):  
Point Of Care ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
High Specificity ◽  
Current Treatment ◽  
Point Of Care Testing ◽  
Blood Samples ◽  
Point Of Care Test ◽  
Treatment Thresholds ◽  
Time Point

Abstract Edoxaban, alongside other direct oral anticoagulants (DOAC), is increasingly used for prevention of thromboembolism, including stroke. Despite DOAC therapy, however, annual stroke rate in patients with atrial fibrillation remains 1–2%. Rapid exclusion of relevant anticoagulation is necessary to guide thrombolysis or reversal therapy but, so far, no data exists on the effect of edoxaban on available point-of-care test systems (POCT). To complete our previous investigation on global coagulation-POCT for the detection of DOAC, we evaluated whether CoaguChek®-INR (CC-INR) is capable of safely ruling out edoxaban concentrations above the current treatment thresholds of 30/50 ng/mL in a blood sample. We studied patients receiving a first dose of edoxaban; excluding subjects receiving other anticoagulants. Six blood samples were collected from each patient: before drug intake, 0.5, 1, 2 and 8 h after intake, and at trough (24 h). CC-INR and mass spectrometry for edoxaban concentrations were performed for each time-point. One hundred and twenty blood samples from 20 patients contained 0–302 ng/mL of edoxaban. CC-INR ranged from 0.9 to 2.3. Pearson’s correlation coefficient showed strong correlation between CC-INR and edoxaban concentrations (r = 0.73, p < 0.001). Edoxaban concentrations > 30 and > 50 ng/mL were ruled out by CC-INR ≤ 1.0 and ≤ 1.1, respectively, with high specificity (> 95%), and a sensitivity of 44% (95%-confidence interval: 30–59%) and 86% (74–93%), respectively. Our study represents the first evaluation of coagulation-POCT in edoxaban-treated patients. CC-POCT is suitable to safely exclude clinically relevant edoxaban concentrations prior to thrombolysis, or guide reversal therapy in stroke patients.

scholarly journals A CRISPR-based SARS-CoV-2 diagnostic assay that is robust against viral evolution and RNA editing

2020 ◽  
Author(s):  
Kean Hean Ooi ◽  
Jie Wen Douglas Tay ◽  
Seok Yee Teo ◽  
Mengying Mandy Liu ◽  
Pornchai Kaewsapsak ◽  
...  
Keyword(s):  
Rna Editing ◽  
Point Of Care ◽  
Viral Evolution ◽  
Turnaround Time ◽  
Human Cells ◽  
Quantitative Real Time Pcr ◽  
Point Of Care Testing ◽  
Single Nucleotide ◽  
Point Of Care Test ◽  
Single Nucleotide Variations

AbstractExtensive testing is essential to break the transmission of the new coronavirus SARS-CoV-2, which causes the ongoing COVID-19 pandemic. Recently, CRISPR-based diagnostics have emerged as attractive alternatives to quantitative real-time PCR due to their faster turnaround time and their potential to be used in point-of-care testing scenarios. However, existing CRISPR-based assays for COVID-19 have not considered viral genome mutations and RNA editing in human cells. Here, we present the VaNGuard (Variant Nucleotide Guard) test that is not only specific and sensitive for SARS-CoV-2, but can also detect the virus when its genome or transcriptome has evolved or has been edited by deaminases in infected human cells. We show that an engineered AsCas12a enzyme is more tolerant of mismatches than wildtype LbCas12a and that multiplexed Cas12a targeting can overcome the presence of single nucleotide variations. Our assay can be completed in 30 minutes with a dipstick for a rapid point-of-care test.

scholarly journals Validation of a Novel IoT and AI based Point-of-Care Testing Laboratory: Analytical Accuracy and Clinical Agreement

2021 ◽  
Author(s):  
Lucca Malucelli ◽  
Gabriele Luise Neves Alves ◽  
Carolina Melchioretto dos Santos ◽  
Matheus Severo ◽  
Victor Henrique Alves Ribeiro ◽  
...  
Keyword(s):  
Influenza A ◽  
Point Of Care ◽  
Pearson Correlation ◽  
Turnaround Time ◽  
Clinical Samples ◽  
Point Of Care Testing ◽  
Reliable Performance ◽  
25 Hydroxy Vitamin D ◽  
Analytical Accuracy ◽  
Kappa Agreement

Point-of-care testing (POCT) offers several advantages over traditional laboratory testing. Offering less invasive testing with a faster turnaround time is not enough if not associated with an acceptable level of accuracy. Here, we show the analytical validation behind the multi-analyte POCT immunochromatography analyser, Hilab Flow (HiF). Analyses from 4,518 clinical samples were compared to College of American Pathologists accredited laboratories for ten quantitative and thirteen qualitative exams. Compatibility between methods was evaluated in terms of association/correlation and clinical agreement. Strong correlation/ concordance was observed between quantitative (CHOL, HDL-c, TG, HbA1c, Glycemia, 25-Hydroxy Vitamin D, TSH, Uric Acid, Creatinine, Urea) and qualitative methods (COVID-19 IgG/ IgM, Beta-hCG, Syphilis, Anti-HBsAg, Zika IgG/ IgM, Influenza A/B, HIV, HCV, HBsAg, Dengue NS1, COVID-19 Ag, Dengue IgG/ IgM, PSA). Approval criteria was obtaining a kappa agreement > 0.8 or a Pearson correlation > 0.9 depending on the exam. Overall percentage agreement was greater than 95% for all exams, indicating a good clinical agreement to gold-standard laboratory-based tests. Results indicate all exams are suitable for POCT and present a reliable performance. Data support the analyser is a useful tool to aid decision-making at the clinical setting, with potential to contribute with healthcare solutions in diagnostic medicine worldwide.

Integration between point-of-care cardiac markers in an emergency/cardiology department and the central laboratory: methodological and preliminary clinical evaluation

2005 ◽  
Vol 43 (2) ◽  
Author(s):  
Francesca Di Serio ◽  
Gianfranco Amodio ◽  
Lucia Varraso ◽  
Maurizio Campaniello ◽  
Paola Coluccia ◽  
...  
Keyword(s):  
Total Quality Management ◽  
Point Of Care ◽  
Rapid Assessment ◽  
Turnaround Time ◽  
Cardiac Markers ◽  
Total Quality ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Cardiac Marker ◽  
Cardiology Department

AbstractTo achieve rapid assessment of chest pain in emergency/cardiology departments, a short turnaround time for cardiac marker testing is necessary. Nevertheless, Total Quality Management principles must be incorporated into the management of point-of-care testing (POCT); in this setting we implemented the Stratus CS

scholarly journals Clinical, Operative, and Economic Outcomes of the Point-of-Care Blood Gases in the Nephrology Department of a Third-Level Hospital

2020 ◽  
Vol 144 (10) ◽  
pp. 1209-1216
Author(s):  
Ana Laila Qasem Moreno ◽  
Paloma Oliver Sáez ◽  
Pilar Fernández Calle ◽  
Gloria del Peso Gilsanz ◽  
Sara Afonso Ramos ◽  
...  
Keyword(s):  
Point Of Care ◽  
Blood Gas Analysis ◽  
Turnaround Time ◽  
Gas Analysis ◽  
Economic Outcomes ◽  
Blood Gas ◽  
Point Of Care Testing ◽  
Total Cost ◽  
Elapsed Time ◽  
The Impact

Context.— Point-of-care testing allows rapid analysis and short turnaround times. To the best of our knowledge, the present study assesses, for the first time, clinical, operative, and economic outcomes of point-of-care blood gas analysis in a nephrology department. Objective.— To evaluate the impact after implementing blood gas analysis in the nephrology department, considering clinical (differences in blood gas analysis results, critical results), operative (turnaround time, elapsed time between consecutive blood gas analysis, preanalytical errors), and economic (total cost per process) outcomes. Design.— A total amount of 3195 venous blood gas analyses from 688 patients of the nephrology department before and after point-of-care blood gas analyzer installation were included. Blood gas analysis results obtained by ABL90 FLEX PLUS were acquired from the laboratory information system. Statistical analyses were performed using SAS 9.3 software. Results.— During the point-of-care testing period, there was an increase in blood glucose levels and a decrease in pCO2, lactate, and sodium as well as fewer critical values (especially glucose and lactate). The turnaround time and the mean elapsed time were shorter. By the beginning of this period, the number of preanalytical errors increased; however, no statistically significant differences were found during year-long monitoring. Although there was an increase in the total number of blood gas analysis requests, the total cost per process decreased. Conclusions.— The implementation of a point-of-care blood gas analysis in a nephrology department has a positive impact on clinical, operative, and economic terms of patient care.

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