Clinical Reliability of point-of-care tests to support community based acute ambulatory care

2020 ◽  
Vol 19 (1) ◽  
pp. 4-14
Author(s):  
Jan Y Verbakel ◽  
◽  
Charlotte Richardson ◽  
Tania Elias ◽  
Jordan Bowen ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Clinical Chemistry ◽  
Point Of Care ◽  
Community Dwelling ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Community Based ◽  
Sodium Potassium ◽  
Point Of Care Tests ◽  
Acceptable Agreement

Objective: To ensure clinicians can rely on point-of-care testing results, we assessed agreement between point-of-care tests for creatinine, urea, sodium, potassium, calcium, Hb, INR, CRP and subsequent corresponding laboratory tests. Participants: Community-dwelling adults referred to a community-based acute ambulatory care unit. Interventions: The Abbott i-STATTM (Hb, clinical chemistry, INR) and the AfinionTM Analyser (CRP) and corresponding laboratory analyses. Outcomes: Agreement (Bland-Altman) and bias (Passing-Bablok regression). Results: Among 462 adults we found an absolute mean difference between point-of-care and central laboratory analyses of 6.4g/L (95%LOA -7.9 to +20.6) for haemoglobin, -0.5mmol/L (95%LOA -4.5 to +3.5) for sodium, 0.2mmol/L (95%LOA -0.6 to +0.9) for potassium, 0.0mmol/L (95%LOA -0.3 to +0.3) for calcium, 9.0 μmol/L (95%LOA -18.5 to +36.4) for creatinine, 0.0mmol/L (95%LOA -2.7 to +2.6) for urea, -0.2 (95%LOA -2.4 to +2.0) for INR, -5.0 mg/L (95%LOA -24.4 to +14.4) for CRP. Conclusions: There was acceptable agreement and bias for these analytes, except for haemoglobin and creatinine.

Haemoglobin A1c: evaluation of a new HbA1c point-of-care analyser Bio-Rad in2it in comparison with the DCA 2000 and central laboratory analysers

2009 ◽  
Vol 46 (5) ◽  
pp. 373-376 ◽  
Author(s):  
Chin-Pin Yeo ◽  
Carol Hui-Chen Tan ◽  
Edward Jacob
Keyword(s):  
Point Of Care ◽  
Outpatient Setting ◽  
Haemoglobin A1c ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Laboratory Methods ◽  
Deming Regression ◽  
Difference Test ◽  
Roche Cobas ◽  
Hba1c Levels

Background Point-of-care-testing (POCT) of haemoglobin Alc (HbA1c) is popular due to its fast turnaround of results in the outpatient setting. The aim of this project was to evaluate the performance of a new HbA1c POCT analyser, the Bio-Rad in2it, and compare it with the Siemens DCA 2000, Bio-Rad Variant II and Roche Tina-quant HbA1c Gen 2 assay on the cobas c501. Methods Imprecision of the four methods were compared by computing total imprecision from within-run and between-run data. A total of 80 samples were also compared and analysed by Deming regression and Altman–Bland difference test. Results Study of total imprecision of the in2it at HBA1c levels of 6.0% and 10.4% produced a coefficient of variation (%CV) of 3.8% and 3.7%, respectively. These results were more favourable as compared with the DCA 2000 but did not match the low imprecision of the central laboratory methods, the Bio-Rad Variant II and the Roche cobas c501. Comparison between the in2it and the central laboratory analysers, Bio-Rad variant II and cobas c501, revealed positive bias of 12% and 10%, respectively, supported by corresponding Deming regression equation slopes of +1.18 and +1.14. Comparison between the DCA 2000 and the central laboratory analysers revealed a bias that became increasingly positive with rising HbA1c concentrations with Deming regression analysis also revealing proportional and constant differences. Conclusions The in2it is a suitable POCT analyser for HbA1c but its less than ideal precision performance and differences with the central laboratory analysers must be communicated to and noted by the users.

scholarly journals Impact of point-of-care testing on patients' length of stay in a large emergency department

1996 ◽  
Vol 42 (5) ◽  
pp. 711-717 ◽  
Author(s):  
C A Parvin ◽  
S F Lo ◽  
S M Deuser ◽  
L G Weaver ◽  
L M Lewis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Point Of Care ◽  
Control Period ◽  
Experimental Period ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Acceptable Accuracy ◽  
Patient Interview ◽  
Combined Control

Abstract We prospectively investigated whether routine use of a point-of-care testing (POCT) device by nonlaboratory operators in the emergency department (ED) for all patients requiring the available tests could shorten patient length of stay (LOS) in the ED. ED patient LOS, defined as the length of time between triage (initial patient interview) and discharge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POCT device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of the hand-held device. Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use. Among nearly 15 000 ED patient visits during the study period, 4985 patients (2067 during the experimental period and 2918 during the two control periods) had at least one Na, K, Cl, BUN, or Gluc test ordered from the ED. However, no decrease in ED LOS was observed in the tested patients during the experimental period. Median LOS during the experimental period was 209 min vs 201 min for the combined control periods. Stratifying patients by presenting condition (chest pain, trauma, etc.), discharge/admit status, or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period. From these observations, we consider it unlikely that routine use of a hand-held POCT device in a large ED such as ours is sufficient by itself to impact ED patient LOS.

scholarly journals Formulating Design Recommendations for the Acceptance of the Use and Results of Point-of-Care Testing in Low- and Middle-Income Countries: A Literature Review

2019 ◽  
Vol 1 (1) ◽  
pp. 2795-2804
Author(s):  
Yvonne Jolanda Melanie Licher ◽  
Jan Simon Visser ◽  
G-Young Van ◽  
Jan Carel Diehl
Keyword(s):  
Healthcare Workers ◽  
Point Of Care ◽  
Waiting Times ◽  
Point Of Care Testing ◽  
Middle Income ◽  
Future Design ◽  
Middle Income Countries ◽  
Barriers And Opportunities ◽  
Point Of Care Tests ◽  
Low And Middle Income

AbstractIn low- and middle-income countries (LMIC), diagnostics are not always available in remote areas. Hospitals and healthcare centres are often too far from the community, and waiting times are up to a few hours even for relatively simple procedures. Moreover, travelling to the healthcare centre and taking the diagnostic test is frequently unaffordable. Point of Care Tests (POCTs) can improve the availability, accessibility and affordability of the diagnostics by providing the test at the time and place of patient care. Although many POCTs have been developed already, there remain challenges to enable the healthcare workers (HCW) and the patients to use the device in practice. In this paper, we aim to provide a systemic overview of the barriers and opportunities for the adoption of use and acceptance of the results of POCTs based on the literature. The barriers and opportunities were clustered into six themes and used to draw out recommendations for the future design.

scholarly journals Current Status of Clinical Application of Point-of-Care Testing

2020 ◽  
Author(s):  
Hyung-Doo Park
Keyword(s):  
Clinical Application ◽  
Clinical Pathways ◽  
Clinical Chemistry ◽  
Point Of Care ◽  
Health Care Systems ◽  
Molecular Genetic ◽  
Current Status ◽  
Point Of Care Testing ◽  
Genetic Method ◽  
Care Systems

Context.— The clinical applications of point-of-care testing (POCT) are gradually increasing in many health care systems. Recently, POCT devices using molecular genetic method techniques have been developed. We need to examine clinical pathways to see where POCT can be applied to improve them. Objective.— To introduce up-to-date POCT items and equipment and to provide the content that should be prepared for clinical application of POCT. Data Sources.— Literature review based on PubMed searches containing the terms point-of-care testing, clinical chemistry, diagnostic hematology, and clinical microbiology. Conclusions.— If medical resources are limited, POCT can help clinicians make quick medical decisions. As POCT technology improves and menus expand, areas where POCT can be applied will also increase. We need to understand the limitations of POCTs so that they can be optimally used to improve patient management.

scholarly journals Editorial Volume 19 Issue 1 – “Eternal Winter”: Acute Medicine the key to providing longer periods of summer

2020 ◽  
Vol 19 (1) ◽  
pp. 2-3
Author(s):  
Tim Cooksley ◽  
Keyword(s):  
Respiratory Rate ◽  
Ambulatory Care ◽  
Acute Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Point Of Care Testing ◽  
Acute Medicine ◽  
Care Services ◽  
Acute Care Services ◽  
The Impact

As another winter season passes, many colleagues will continue to be working under immense pressures striving to provide high quality care for increasingly larger numbers of patients. The work of Acute Medicine teams to keep the “front door” safe are fundamental to the delivery and sustainability of acute care services. The challenges of innovating and enacting positive changes at times of such high service demand are not insignificant; but the specialty is blessed with rapidly expanding driven and dedicated international, national and local leaders. The first winter SAMBA has recently been performed. SAMBA is an increasingly rich data source that will serve both nationally and locally to help improve performance and ultimately patient outcomes.1 Higher quality Acute Medicine is being produced. Acute Physicians are leading in many acute sub-specialties. Pleasingly, there has a been a significant rise in the number of trainees applying to train in Acute Medicine in the UK reflecting the traction the specialty is achieving. Ambulatory care remains a fundamental tenet to the sustainability of acute care services. Point of care testing is a key element in driving efficient performance in this setting and in this issue Verbakel et al. perform an important analysis on the reliability of point of care testing to support community based ambulatory care.2 This work should field the way for further research defining the impact of point of care testing and how it should be implemented in ambulatory clinical practice. The performance of respiratory rate observation remains poorly performed in acute care settings despite its well validated predictive value. Nakitende et al. describe an app that allows respiratory rate to calculated more quickly and accurately by using a touch screen method.3 Technological innovations to improve the recording and accuracy of physiological parameters in acute care, which can also be used in resource poor settings, will be a focus of large quantities of research in the upcoming years. Blessing et al. describe an important modelling study on the impact of integrated radiology units.4 Co-ordination between Acute Medicine and Radiology departments is essential in a high functioning AMU, especially as increasingly Acute Physicians are trained in point of care ultrasound. Lees-Deutsch et al. provide a fascinating insight into the patient’s perspective of discharge lounges.5 Often used to help maintain flow through the hospital, they elucidate that patients and caregivers transferred from AMU do not find this aspect of their journey a positive one. In times of significant organisational pressures, it is important that clinicians continue to examine the impact of flow measures on the quality of patient care and experience.

scholarly journals Comparison Analysis of Total Cholesterol Level Examination Between Photometry and 3 Parameters Point of Care Testing Device

2018 ◽  
Vol 4 (2) ◽  
pp. 49
Author(s):  
Perdina Nursidika ◽  
Wikan Mahargyani ◽  
Fitri Kurnia Anggraeni
Keyword(s):  
Linear Regression ◽  
Total Cholesterol ◽  
Clinical Chemistry ◽  
Point Of Care ◽  
Total Cholesterol Level ◽  
Total Error ◽  
Clinical Pathology ◽  
Hdl Cholesterol ◽  
Point Of Care Testing ◽  
Pap Method

Total cholesterol is the composition of many substances including cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol. Cholesterol examination is one of the most frequent tests required in the laboratory to monitor vascular and cardiovascular diseases. Most clinical pathology laboratories use photometer to perform clinical chemistry checks. Cholesterol testing can also be done with Point of Care Testing (POCT) which has a working principle of biosensor technology. This research method is experimental, using 40 samples that can represent normal and pathological levels. All samples will be checked for total cholesterol with a photometer of CHOD-PAP method and 3 POCT Lipid Pro. The results showed linear regression y = 0.955x + 1.8325 with R2 of 0.9955. The linear regression value is calculated by Total Error (TE), while the Total Error Allowable (TEa) cholesterol is 10%. The bias value is 0.31%, TE for normal level = 5.92% and TE for high pathological level = 3.00%, it can be stated the result of examination can be compared or accepted. The% TE value obtained is less than the TEa value of cholesterol. It can be concluded that the total cholesterol results examined by the photometer and LipidPro are comparable. For further research it is advisable to use a total cholesterol sample that has a value of more than 400 mg/dL.

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