While POCT represents an important advance in patient care, healthcare providers must use it discerningly and back up its use with evidence-based data.
In laboratory diagnostics, the field of Point of Care testing (POCT) is relatively young. However, due to changing technology, utilization of POCT and the breadth of its applications in the healthcare system have expanded tremendously. POCT is clinical laboratory testing conducted close to the site of patient care, typically by patients or clinical personnel whose primary training is not in the clinical laboratory sciences. POCT refers to any testing performed outside of the traditional, core or central laboratory. While POCT represents an important advance in patient care, healthcare providers must use it discerningly and back up its use with evidence-based data. Overuse or incorrect utilization of POCT could potentially increase the cost of care, or even delay lifesaving treatment.
Clinicians, laboratorians and healthcare administrators need guidance in the effective utilization of POCT. There is a proliferation of misinformation regarding POCT. Faster results are often understood to mean better outcomes, without research to support this conclusion. Hospital systems, wanting faster turnaround time of laboratory results in order to move patients faster through the system, often see POCT as a solution to remove patient bottlenecks. There is also a tendency for physicians to equate new technology with better patient care. Thus, it is essential that each lab or testing site research new test requests to determine clinical utility and cost-effectiveness, as well as management and reimbursement issues.
Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It is the integration of best research evidence with clinical expertise and patient values. Best research evidence includes both clinically relevant studies and research in the basic sciences. It is patient-centered, looking at the accuracy and precision of diagnostic tests, the power of prognostic markers and the efficacy and safety of therapeutic, rehabilitative and preventive regimens. Clinical expertise incorporates the ability to use clinical skills and past experience to identify the patient’s unique health state, diagnosis, risks and benefits of interventions and the patient’s personal values and expectations. Finally, the patient’s unique preferences, concerns and expectations have to be taken into account and integrated into clinical decisions.
EBM offers fact-based support for medical decision-making, reducing subjectivity and practice variability.
POCT is an increasingly popular means of delivering laboratory testing. When used appropriately, POCT can improve patient outcomes by providing faster results and earlier therapeutic interventions. However, when over-utilized or incorrectly performed, POCT presents a patient risk and potential for increased cost of healthcare. It important that the practice of POCT be evidence-based. EBM offers fact-based support for medical decision-making, reducing subjectivity and practice variability. It is also important to separate the facts from conjecture when implementing and utilizing POCT devices, and to define the mechanisms and strategies for optimizing health outcomes.
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