POC Programs: A Brief Survey on Critical Value Thresholds, Instrumentation, Repeat Testing, and Training Documentation

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S35-S36
Author(s):  
B Castle ◽  
E Vonlinsowe ◽  
B Cook ◽  
J Hayward ◽  
G Sharma
Keyword(s):  
Online Survey ◽  
Clinical Chemistry ◽  
Point Of Care ◽  
The United States ◽  
Critical Value ◽  
Critical Values ◽  
Repeat Testing ◽  
Record Keeping ◽  
Almost All ◽  
Result Management

Abstract Introduction/Objective Across the United States, Point of Care (POC) programs oversee glucometer testing and are often expected to enforce thresholds for critical values, as well as provide guidance on repeat testing. Additionally, POC must track training and ongoing competency assessments of glucometer operators. Our aim was to survey POC across North America to capture the current state of variation in these POC functions, and identify opportunities for standardization. Methods/Case Report In July of 2021, an online survey was created on www.surveymonkey.com and distributed via the POC listserv of the American Association for Clinical Chemistry (AACC). The survey listed nine questions regarding instrumentation, threshold levels for critical-high and critical-low, policies on repeat testing, and practices around documentation and record retention. Results (if a Case Study enter NA) Of the 63 responses received, almost all (95.2%, n=60) indicated that their institution defines glucometer critical value thresholds. Of these, the most common threshold for critical-high was 400 mg/dL (44.4%, n=28) and for critical-low was 50 mg/dL (39.7%, n=25). A majority (55.5%, n=35) of programs require repeat testing of results that exceeded critical limits. The most popular POC result management software (50.8%, n=32) was RALS (Abbott Diagnostics, Chicago, IL) and the most popular glucometer (56%, n=23) was Roche Accu- Chek Inform II (Roche Diagnostics, Basel, Switzerland). Regarding institutions that disclosed training and competency documentation practices (93.7%, n=59), a majority (57.6%, n=34) used online-only storage, followed by hybrid online- paper storage (32.2%, n=19), and paper-only storage (10.2%, n=6). Conclusion Our brief survey has uncovered variations and insights that should raise queries on the feasibility of standardized critical value thresholds, as well as uniform recommendations for retesting critical values. We observed widespread adoption of middleware, as well as online record-keeping. We hope that our findings will trigger further discussions and follow-up studies by other researchers in the POC field.

scholarly journals Osteopathic Manipulative Medicine in the Era of the Single Accreditation System: Can the Past Guide the Way to the Future of OMM?

2020 ◽  
Vol 30 (1) ◽  
pp. 17-28
Author(s):  
David M. Kanze
Keyword(s):  
American Academy ◽  
Online Survey ◽  
Gross Anatomy ◽  
The United States ◽  
Human Anatomy ◽  
After School ◽  
Chi Square ◽  
Chi Square Test ◽  
English Speaking ◽  
Almost All

Abstract The purpose of this study was twofold: 1) to evaluate the education of osteopathic physicians who integrate osteopathic manipulative medicine in practice and attempt to find key factors that might be viewed as best practices to be adopted by colleges of osteopathic medicine (COMs), Departments of Osteopathic Manipulative Medicine (OMM), and postgraduate training programs; and 2) to evaluate if gross human anatomy was seen as valuable in OMM training. A 31-question, online survey was distributed to English-speaking members of the American Academy of Osteopathy (AAO) in the United States from July through October of 2016. Of the 438 respondents, 325 (74.3%) reported having a mentor in osteopathic manipulative medicine (OMM) or osteopathic manipulative treatment (OMT) while in school. In addition, 270 (61.6%) had dedicated time to practice OMT while in school, with 186 (42.5%) practicing supervised in a school clinic, 340 (77.6%) practicing during an undergraduate rotation, and 244 (55.7%) practicing after school hours. Many of the mentees participated in several of the above activities. Chi square test was applied to participants who are Fellows of the American Academy of Osteopathy (FAAOs). This test revealed that 24 of 26 (92.3%) of FAAOs, who responded, had a mentor, a statistically significant relationship between having an OMT/OMM mentor and becoming an FAAO (P=.03). Almost all survey participants (438 [99.5%]) had some type of gross anatomy while in medical school. The majority of respondents (321 [73.8%]) performed dissections, 81 (18.6%) had both prosection and dissections, 33 (7.6%) only had prosection, and 321 (73.8%) found that it was extremely helpful in their OMM training. In comparison, 341 respondents (78.2%) reported that gross anatomy was important to their specialty. The survey clearly demonstrated that early exposure to an OMM mentor leads to increased use of OMT and OMM and that a strong foundation in gross human anatomy was found to be useful for physicians across specialty training, including OMM.

Attitudes and Beliefs of Pathology Residents Regarding the Subspecialty of Clinical Chemistry: Results of a Survey

2016 ◽  
Vol 141 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Mehran Haidari ◽  
Marwan Yared ◽  
Juan P. Olano ◽  
C. Bruce Alexander ◽  
Suzanne Z. Powell
Keyword(s):  
United States ◽  
Online Survey ◽  
Clinical Chemistry ◽  
The United States ◽  
Survey Analysis ◽  
Residency Programs ◽  
Anatomic Pathology ◽  
Survey Results ◽  
Time To Learn ◽  
Supportive Learning Environment

Context.—Previous studies suggest that training in pathology residency programs does not adequately prepare pathology residents to become competent in clinical chemistry. Objectives.—To define the beliefs of pathology residents in the United States regarding their preparation for practicing clinical chemistry in their career, their attitude toward the discipline, and the attractiveness of clinical chemistry as a career. Design.—The residents of all pathology residency programs in the United States were given the opportunity to participate in an online survey. Results.—Three hundred thirty-six pathology residents responded to the survey. Analysis of the survey results indicates that pathology residents are more likely to believe that their income may be lower if they select a career that has a clinical chemistry focus and that their faculty do not value clinical chemistry as much as the anatomic pathology part of the residency. Residents also report that clinical chemistry is not as enjoyable as anatomic pathology rotations during residency or preferable as a sole career path. A large proportion of residents also believe that they will be slightly prepared or not prepared to practice clinical chemistry by the end of their residency and that they do not have enough background and/or time to learn clinical chemistry during their residency programs to be able to practice this specialty effectively post graduation. Conclusions.—Our survey results suggest that many pathology residents do not have a positive attitude toward clinical chemistry and do not experience a supportive learning environment with an expectation that they will become competent in clinical chemistry with a residency alone.

scholarly journals Institutional Training Opportunities for PhD Students in Laboratory Medicine: An Unmet Career Development Need?

2020 ◽  
Vol 5 (2) ◽  
pp. 412-416
Author(s):  
Jennifer M Colby ◽  
Ferrin C Wheeler ◽  
Kimberly A Petrie ◽  
Kathleen L Gould ◽  
Jonathan E Schmitz
Keyword(s):  
Online Survey ◽  
Clinical Chemistry ◽  
The United States ◽  
Laboratory Medicine ◽  
Early Career ◽  
Postdoctoral Training ◽  
Career Training ◽  
Local Institution ◽  
The Status ◽  
Training Opportunities

Abstract In the United States, the credentialing of PhD-scientists as medical directors of clinical laboratories is driven by formal postdoctoral training programs. Prior to acceptance in one these accredited fellowships, however, a trainee’s exposure to the field can be far less standardized, with significant ramifications for their awareness and competitiveness. In the current article, we describe our recent experiences in developing local, institution-based immersion opportunities for PhD experiences in the subdisciplines of laboratory medicine (clinical microbiology, clinical chemistry, and molecular genetics/genomics). It is our hope that this article—and a corresponding online survey—can prompt reflection and discussion on the status of early career training opportunities in these key clinical areas.

To Repeat or Not to Repeat: An Evaluation of Critical Values in Chemistry Laboratory Testing

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S14-S15
Author(s):  
Ridin Balakrishnan ◽  
Stefanie Forest
Keyword(s):  
Laboratory Data ◽  
Clinical Intervention ◽  
Critical Value ◽  
Critical Values ◽  
Absolute Difference ◽  
Potential Cost ◽  
Original Result ◽  
Repeat Testing ◽  
Percentage Difference ◽  
Significant Difference

Abstract It is common laboratory practice to repeat critical values before reporting the result. However, the benefits of repeat testing are unclear. There are slight differences in values whenever tests are repeated, owing to the inherent imprecision of instruments. Repeating critical values delays reporting of results and, ultimately, clinical intervention. Modern instruments have ultrasensitive level sensors, clot detectors, and better precision, making this practice costly and clinically inefficient. This study aimed to evaluate critical values pairs (original and repeats) to determine if repeats were necessary. Our instruments are programmed to automatically repeat critical values for several analytes. In total, 3,891 critical value pairs (potassium, n = 1111; sodium, n = 677; glucose, n = 987; calcium, n = 214; phosphorus, n = 86; magnesium, n = 399; and bicarbonate/CO2, n = 417) that were performed from April to July 2018 at our core laboratory were analyzed. Data were extracted using software developed to evaluate clinical laboratory data for quality assurance. Analysis of the distribution of critical values within and outside the analytical measurement range (AMR) for each of the analytes was performed. The repeat pairs were analyzed for significant differences (>CAP allowable error), mean absolute and percentage difference between the two determinations, and the number of results that were no longer critical on repeat testing. A cost-time analysis was also performed. For all critical values, a total of 49 (1.26%) showed significant differences between the initial and the repeated results. There were significant differences in 35 (0.92%) of the 3,800 repeats within and in 14 (15.38%) of the 91 repeats outside the AMR. For the 3,800 critical values within the AMR, the mean absolute difference and percent difference between the two testing determinations were: potassium, 0.02 mmol/L (0.42%); sodium, 0.19 mmol/L (0.13%); glucose, 0.44 mg/dL (0.16%); calcium, 0.01 mg/dL (0.14%); phosphorus, 0.01 mg/dL (0.16%); magnesium, 0.01 mg/dL (0.31%); and bicarbonate (CO2), 0.57 mEq/L (1.73%), respectively. A total of 254 (6.53%) initial critical values turned out to be noncritical when repeated, although most were just above or below the cutoff. During the study period, the analytical time for critical value repeats was around 355 hours and the cost was just over $1,300. Data from our study suggest that repeated testing is very similar to the original result and therefore redundant. A higher percentage of results had a significant difference when outside the AMR and repeating just these results can be considered. This study did not capture results that were just below or above the critical value cutoffs, and several of these would have likely been critical on repeat testing. Our analysis suggests that these chemistry critical values should not be routinely repeated, allowing for potential cost savings and improved patient care by reporting critical values sooner, resulting in faster clinical intervention.

scholarly journals Utility and Necessity of Repeat Testing of Critical Values in the Clinical Chemistry Laboratory

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e80663 ◽  
Author(s):  
Aijun Niu ◽  
Xianxia Yan ◽  
Lin Wang ◽  
Yan Min ◽  
Chengjin Hu
Keyword(s):  
Clinical Chemistry ◽  
Critical Values ◽  
Chemistry Laboratory ◽  
Repeat Testing ◽  
Clinical Chemistry Laboratory

scholarly journals Critical laboratory values - an experience in Apollo Hospitals Dhaka

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 7-11
Author(s):  
M Ibrahim ◽  
I Islam ◽  
TA Nasir ◽  
D Saha
Keyword(s):  
Patient Safety ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Medical Center ◽  
Clinical Care ◽  
Time Factors ◽  
Critical Value ◽  
Critical Values ◽  
Healthcare Organizations ◽  
Value Reporting

Reporting of laboratory critical values has become important for patient safety as described by recent guidelines in National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The use of critical values reporting was adopted as a requirement in the Clinical Laboratory Improvement Amendments (CLIA'88). Herein, we reported the results of an analysis of 4260 consecutive laboratory critical values from July 2007 to June 2008 at our institution, a large tertiary medical center. We evaluated critical value reporting by parameters, laboratory speciality (Clinical Chemistry & Hematology), clinical care area (IPD, OPD, Emergency), and Turn around time. Factors leading to delays in critical value reporting are identified, and we describe approaches to improving this important operational and patient safety.DOI: 10.3329/pulse.v3i1.6544Pulse Vol.3(1) July 2009 p7-11

In Vitro Diagnostics for COVID-19: State-of-the-Art, Future Directions and Role in Pandemic Response

2021 ◽  
Author(s):  
Sandeep Kumar Vashist ◽  
Subramanian Murugan ◽  
Guiffo Djoko
Keyword(s):  
Point Of Care ◽  
Immunoglobulin A ◽  
The United States ◽  
Immunoglobulin M ◽  
In Vitro Diagnostics ◽  
Rt Pcr ◽  
United States Food ◽  
States Food ◽  
Almost All

There have been tremendous advances in in vitro diagnostics (IVD) for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the confirmatory clinical diagnosis is made by real-time reverse transcriptase polymerase chain reaction (RT-PCR), lateral flow immunoassay (LFIA) based viral antigen (Ag) detection is used for mass population screening at point-of-care (POC) settings. The rapid RT-PCR tests (such as from Cepheid and Bosch) have an assay duration of less than 40 min, while most rapid Ag tests (such as Abbott’s BinaxNOW™ COVID-19 Ag card) have an assay duration of about 15 min. Of interest is the POC molecular test (ID NOW™) from Abbott that takes less than13 min. Similarly, many immunoassays (IAs), i.e., automated chemiluminescent IA (CLIA), manual ELISA, and LFIA, have been developed to detect immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) produced in subjects after SARS-CoV-2 infection. Many IVD tests have been approved by the United States Food and Drug Administration (FDA) under emergency use authorization (EUA), and almost all IVD tests are Conformité Européenne (CE) certified.

scholarly journals A study to assess the critical result reporting at B &C Medical College and teaching hospital

2018 ◽  
Vol 8 (2) ◽  
pp. 1350-1352
Author(s):  
Sujan Sharma ◽  
Barsha Koirala ◽  
Niraj Keyal
Keyword(s):  
Teaching Hospital ◽  
Critical Value ◽  
Critical Values ◽  
Care Providers ◽  
Medical College ◽  
Repeat Test ◽  
Adequate Care ◽  
Almost All ◽  
Heath Care

Background: The critical value can occur while performing panels of tests at laboratory by different chemistry or blood analysers with varieties of principles. The main objective of the study was to study the process of critical result reporting and to know the way of communication and documentation done for critical value in the laboratory, ICUs and the wards.Materials and Methods: This study was prospective and non-experimental was conducted at B&C Medical College and Teaching Hospital from 14.04.2018 to 14.05.2018. Total 60 critical values samples were included. The data was collected by means of observing the critical values of inpatient and the process of reporting from the laboratory to the respective wards and ICUs.Results: Out of 60 samples included in our study, there was 100% communication to concerned treating units. For the confirmation of critical value repeat test was done in 68% of cases. In 75% of cases clinicians did follow up. Recording of a critical report in lab was done in 96% of cases and almost all of the critical values 98% were immediately reported to the respective wards by technical staffs. There was no communication in 1.6% of cases to treating units by technical staff. Majority 78% of critical values were communicated by respective wards and ICUs nurses to concerned doctors.Conclusion: Critical value can occur while performing panels of tests at laboratory and reporting such values to treating clinicians or respective wards or ICUs could help heath care providers for effective treatment of the patients and their adequate care.

Attitudes of women participating in a clinical trial on point-of-care testing and home testing for STIs

2020 ◽  
Vol 31 (14) ◽  
pp. 1352-1358
Author(s):  
Karen Chow ◽  
Rina Edi ◽  
Geneen Gin ◽  
Sheldon R Morris
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Point Of Care ◽  
Primary Care Providers ◽  
The United States ◽  
System Level ◽  
Health Concern ◽  
Sti Testing ◽  
Home Based ◽  
Home Testing

Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis infections are a public health concern and cost the United States’ healthcare system 16 billion dollars annually. By minimizing barriers to testing, an increased number of infections can be detected and treated. A home-based point-of-care (POC) sexually transmitted infection (STI) test may reduce personal, structural, social and system-level barriers to STI testing. This study assesses patient preferences and acceptance of home-based POC STI testing. We performed a cross-sectional, single-visit study of women aged 18 years and older at a single site. Women completed an anonymous online survey evaluating interest in POC STI testing, comfort in self-collecting vaginal swabs and participant reaction to a positive STI result. 138 participants completed the anonymous online survey. The survey results indicate high acceptability with self-collection of samples and home POC STI testing. A majority of participants were interested or very interested in a home POC STI device-especially amongst women with a past history of a STI. If receiving a positive test result, participants indicated they would want to have someone to discuss their results with, most preferring to speak with their primary care provider. Women on lower incomes were less comfortable and less interested with home testing. Women are likely to be receptive to home POC STI testing. Adapting to home-based testing will require engagement of primary care providers for management and surveillance of STIs.

scholarly journals 1948. Impact of @WuidQ, a Free Open-access Medical Education Twitter Resource, on Infectious Disease Learning and Teaching

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S57-S58
Author(s):  
Gerome V Escota ◽  
Ige George ◽  
Emily Abdoler
Keyword(s):  
Infectious Disease ◽  
Medical Education ◽  
Open Access ◽  
Online Survey ◽  
The United States ◽  
Multiple Choice Questions ◽  
Learning And Teaching ◽  
Follower Satisfaction ◽  
Common Learning ◽  
Almost All

Abstract Background Free open-access medical education (FOAMed) is increasingly used as a web-based platform for learning/teaching, with Twitter emerging as a leading medium. However, FOAMed resources in infectious disease (ID) are limited. @WuidQ is the first FOAMed Twitter resource to provide review of ID through board-style, multiple-choice questions (MCQs). We describe its creation and impact to date. Methods Two ID faculties created MCQs, vetting them based on accuracy and clarity. MCQs were posted a few times weekly using Twitter’s poll function, with answers tweeted as “threads” linked to the MCQ (Figure 1). We reviewed followers’ profiles to determine their demographics. We also used Twitter metrics to assess participation, including the average number of poll voters, impression (number of tweet views), engagement (number of retweets, clicks), and engagement rate (engagement divided by impression). In order to gauge follower satisfaction, we posted an anonymous online survey that included both close-ended questions utilizing Likert scale and open-ended questions. Results Over its first 9 months, @WuidQ reached 1,339 followers (56% based in the United States, 47% healthcare professionals, 13% students/trainees) (Table 1). During this time, it earned 582,400 impressions and had a 3.1% mean engagement rate. We posted 103 MCQs, with a mean of 143 (range 70–316) poll voters per MCQ. Forty-five followers completed the survey; of whom, 49% were ID doctors, 22% were ID fellows, and 11% were medical residents. The vast majority of respondents were between 25 and 44 years of age. Almost all agreed that @WuidQ is engaging and accessible (Figure 2). The majority of respondents who were taking exams agreed that @WuidQ helped them with test preparation. Of those who indicated teaching was a relevant practice, 80% said it helped them teach ID. Lack of time to read and learners’ short attention span were the most common learning barriers addressed by @WuidQ (Figure 4). Conclusion @WuidQ is an effective Twitter resource for ID education, filling a gap in FOAMed resources for ID. It has a global reach and caters to learners/teachers across a spectrum of training levels. Given its success, more work is warranted to understand practices for engaging learners and teachers in FOAMed for ID. Disclosures All Authors: No reported Disclosures.

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