CE UPDATE—POINT OF CARE III

Richard F. Louie
Zuping Tang, MD
David G. Shelby, MT
Gerald J. Kost, MD, PhD

Point-of-Care Testing:
Millennium Technology

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for Critical Care
ABSTRACT Point-of-care testing (POCT) is an important
diagnostic tool used in various locations in the hospital,
especially in critical care settings such as the intensive care
unit (ICU), the operating room (OR), and the emergency
department (ED).
This is the third article in a 4-part continuing education series on point-of-care
testing. After reading this article, the reader will be able to define POCT, identify its
advantages and disadvantages, explain its benefits in critical care settings,
understand key features in current point-of-care instruments, identify when a point-
of-care test may be inaccurate, and recognize important quality management
features of point-of-care instruments.
From Point-of-Care Laboratory test results are often pivotal to critical care
Testing Center for decisions.1 Testing provides physicians with valuable
Teaching and
Research
knowledge about the criticality of the patient so that
(POCT•CTR), School appropriate therapeutic interventions can be made
of Medicine, quickly. There has been growing interest in decentral-
University of ized laboratory testing, especially point-of-care test-
California, Davis. ing (POCT) in critical care settings (eg, ICU, OR, ED)
Address where rapid therapeutic turnaround time is
correspondence to:
needed.2,3 However, some types of POCT are contro-
Mr Richard F. Louie,
Medical Pathology, versial because of concern about the accuracy and
3453 Tupper Hall, performance of instruments when used with criti-
School of Medicine, cally ill patients (ie, glucose meter testing).4,5
University of
California, Davis,
Point-of-Care Testing Defined
Davis, CA 95616.
E-mail: Point-of-care testing is defined as “testing at or
rflouie@ucdavis.edu near the site of patient care whenever the medical
care is needed.”6 The purpose of POCT is to pro-
vide immediate information to physicians about
the patient’s condition, so that this information
can be integrated into appropriate treatment deci-
sions that improve patient outcomes, that is,
reduce patients’ criticality, morbidity, and mortal-
ity. Point-of-care testing can be performed in dif-
ferent environments, such as in the hospital, at
home, or at other locations.
Types of Point-of-Care Instruments
Point-of-care instruments vary widely and can be cat-
egorized as “transportable,” “portable,” or “handheld,”
based on the format. Some are capable of testing spe-
cific analytes, while others are capable of performing
an array of tests (eg, electrolytes and blood gases).
Tables 1 and 2 list test parameters and specifications of
the latest whole-blood analyzer/biosensor platforms
and handheld/portable glucose meters, respectively.
Point-of-care instruments differ by their
method of testing. For example, whole-blood glu-
cose meters are categorized as “electrochemical
biosensor,” “reflectance photometry,” or
“absorbance photometry.” These instruments are
further differentiated by the type of chemistry used
to measure the glucose: either glucose oxidase or
glucose dehydrogenase enzymes.
Advantages of Point-of-Care Testing
Table 3 summarizes some of the advantages of
POCT. The first advantage of POCT is the short
therapeutic turnaround time of patient sample test-
ing.7,8 The average turnaround time expected by
critical care physicians is 5 to 15 minutes.1 Stat tests
are frequently requested in critical care units.
Depending on the instrument used, the type of test,
and the number of tests performed, the analysis time
of a whole-blood sample can vary from 15 seconds
to 2 minutes 20 seconds (Tables 1 and 2). Delays
could yield results that do not reflect the patient’s
current condition. One benefit of rapid therapeutic
turnaround time is that it allows physicians to begin
implementing appropriate treatment early, especially
for those patients in critical care units where delays
can adversely affect patient outcomes.
A second advantage to POCT is potential reduc-
tion of preanalytic and postanalytic errors. Tradi-
tional methods of laboratory testing involve multiple
preparatory steps. With increased process steps, there
is an increased possibility of introducing preanalytic

402 L A B O R ATO RY M E D I C I N E VO L U M E 3 1 , N U M B E R 7 J U LY 2 0 0 0
 Table 1. Characteristics of Whole-Blood Analyzers
Sample Analysis Time
Instrument Manufacturer Type Volume (mmL) (seconds) Test Analytes (measured)
i-STAT* Abbott Diagnostics, Handheld 65 or 95 90-140 pO2, pCO2, pH, Na+, K+, Ca++,
Abbott Park, IL Cl-, Hct, urea nitrogen, glucose,
lactate, creatinine
AVL OMNI †‡ AVL Scientific, Transportable 40-161 60-90 pO2, pCO2, pH, Na+, K+,
Roswell, GA Ca++, Cl-, Hct, Hb, urea nitrogen,
glucose, lactate, creatinine
AVL OPTI AVL Scientific Portable 125 <120 pO2, pCO2, pH, Na+, K+, Ca++, Cl-, Hb
Rapid Lab 800 Bayer Diagnostics, Transportable 140-175 85 pO2, pCO2, pH, Na+, K+, Ca++, Cl-,
series †

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Norwood, MA glucose, lactate
IRMA SL Agilent Technologies, Portable 125 90 pO2, pCO2, pH, Na+, K+, Ca++, Hct
(series 2000) St Paul, MN
HemoCue HemoCue, Portable 10 45-60 Hb
B-Hemoglobin Mission Viejo, CA
Gem Premier Instrumentation Portable 135 <120 pO2, pCO2, pH, Na+, K+, Ca++, Hct,
3000, 3001§ Laboratory glucose, lactate
Lexington, MA
Stat profile pHOX Nova Biomedical, Transportable 40-70 45 pO2, pCO2, pH,
SO2%, Hct, Hb Waltham, MA
Stat Profile Nova Biomedical Transportable 85-190 78-108 pO2, pCO2, pH, SO2%, Na+, K+, Ca++,
M/M7† Mg++, Cl-, Hct, urea nitrogen, glucose,
lactate, creatinine
Nova series Nova Biomedical Transportable 385 85 Na+, K+, Cl-, Hct, TCO2, Hct, urea
(16) nitrogen, glucose, creatinine
ABL 700 Radiometer, Transportable 55-195 80-135 pO2, pCO2, pH, Na+, K+, Ca++, Cl-,
series † Westlake, OH glucose, lactate
ABL 70 Radiometer Portable <180 <60 pO2, pCO2, pH, Na+, K+, Ca++, Hct
Series
YSI 2300 Yellow Springs Transportable 25 45 Glucose, lactate
Stat Plus Instrument, Yellow

Scientific Communications
Springs, OH
Portable indicates easily carried, usually with a built-in handle; transportable, equipment usually carried on a cart; pO2, blood oxygen tension; pCO2,
blood carbon dioxide tension; SO2%, oxygen saturation; TCO2, total carbon dioxide in blood; Na+, sodium; K+, potassium; Ca++, ionized calcium; Mg++,
magnesium; Cl-, chloride; Hct, hematocrit; Hb, hemoglobin.
* i-STAT test cluster capability is cartridge dependent.
†Co-oximetry available as a modular add-on.
‡AVL OMNI test cluster is instrument-model dependent.
§3100 includes optimal modular prothrombin time (PT), activated partial thromboplastin time (aPTT), and activated clotting time (ACT) tests.

errors.1 Some common preanalytic and postanalytic Point-of-care testing is convenient for clinicians,
errors associated with traditional laboratory testing because it can be performed quickly, and results are
are listed in Table 4. Delays in specimen processing readily available. As point-of-care test menus

and testing may allow samples to degrade. The sub-
sequent testing may yield results that do not repre-
sent the actual status of the patient. This is especially
true when blood gases, pH, and glucose are tested.
Performing tests immediately at the bedside mini-
mizes both preanalytic and postanalytic errors,
because bedside testing eliminates time delays due to
specimen transportation and multiple persons han-
dling a patient specimen. Postanalytic errors can be
minimized because results from bedside testing are
immediately available to the clinical team and can be
printed out or stored in memory by the instrument.
Furthermore, the results are recorded directly onto
the patient’s chart.
4
expand, we will find that based on real-time clinical
Section
need, POCT drives diagnostic testing. Current
point-of-care instruments are user friendly, which
allows nontechnically oriented or nonlaboratory
professionals to operate instruments. Many point-
of-care devices are self-contained with on-screen
instructions, which promote ease of use. Several
point-of-care devices are low maintenance because
they are self-contained, use disposable test car-
tridges, and the test cartridges are readily replaced.
Finally, POCT is advantageous because of the
small sample volume required to perform a test.
Patients potentially lose 25 to 125 mL of blood each
day, or up to 944 mL of blood per hospital stay
through phlebotomy for traditional centralized lab-
oratory testing.8-10 Oftentimes, in the OR, ICU, and

J U LY 2 0 0 0 VO L U M E 3 1 , N U M B E R 7 L A B O R ATO RY M E D I C I N E 403
 Table 2. Characteristics of Glucose Monitoring Devices
Instrument* Manufacturer
HemoCue B-Glucose HemoCue, Mission Viejo, CA
Precision PCx‡ Abbott Diagnostics, Bedford, MA
Precision G Abbott Diagnostics
Precision QID Abbott Diagnostics
SureStepPro LifeScan, Milpitas, CA
One Touch Hospital LifeScan
FastTake LifeScan
Glucometer Elite Bayer, Elkhart, IN
Accu-Chek Advantage H Roche Diagnostics, Indianapolis, IN
Accu-Chek Comfort Curve Roche Diagnostics
* Systems use handheld meters and glucose test strips, except the HemoCue B-Glucose, which is a portable analyzer that uses a
cuvette and photometric absorbance to measure glucose. The SureStepPro and One Touch Hospital test strips use photometric
reflectance. Test strips for the other systems incorporate electrochemical (amperometric) biosensors for glucose measurement.
GO indicates glucose oxidase; GD, glucose dehydrogenase. Test limitations are those provided by the manufacturers and list the
recommended test conditions to yield the optimal results.
ED, there is demand for frequent serial whole-blood
testing. Serial testing of patients with respiratory fail-
ure or distress, acid-base imbalance, or surgery pro-
vides useful trend monitoring, which is helpful when
determining whether current therapy is effective. Serial
whole-blood testing may be as frequent as every 15 to
30 minutes during open heart surgery. Such frequent
laboratory testing results in extensive blood loss, which
could lead to unwarranted transfusions as well to
unforeseen health complications (eg, transfusion-
acquired illness, infections, and iatrogenic anemia). In
the treatment of critically ill patients, minimizing
blood loss is of utmost importance.8,11,12 Point-of-care
instruments are capable of providing a cluster of tests
with minimal blood loss (as low as 40 µL), depending
on the instrument used and the test performed. Cur-
rent point-of-care instruments can provide up to 14
simultaneously measured test parameters (Table 2).
This strategy conserves blood and minimizes health
complications and unnecessary transfusions.12
Disadvantages of Point-of-Care Testing
Table 3 summarizes some of the disadvantages of
POCT. A concern that arises with POCT is the accu-
racy and performance of the instrument when used
in critical care settings. One important question is
whether interfering substances in the specimen can
affect instrument performance. This concern is
especially true in critical care, where changes in
blood gases, pH, glucose, and medication levels can
404 L A B O R ATO RY M E D I C I N E VO L U M E 3 1 , N U M B E R 7 J U LY 2 0 0 0
Sample Volume (m
mL) Analysis Time (seconds)
5 < 90, if [Glu] < 140 mg/dL
< 240, if [Glu] < 400 mg/dL
3.5 20
3.5 20
3.5 20
10 15-45
10 45
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2.5 15
5 30
9-14 45
4 45
pose a potential problem to whole-blood biosen-
sors. Although studies13,14 have documented the
accuracy of point-of-care test results compared with
that of laboratory test results, the accuracy of smaller-
format devices remains controversial (eg, bedside
glucose testing with handheld devices). Recent stud-
ies4,5,15,16 have documented the potential effects of
high or low blood oxygen tension, hematocrit, and
pH levels, which could cause handheld glucose
meters to report higher or lower glucose values.
Because the responsibility of POCT in critical care
is usually assigned to nonlaboratory professionals,2,17
another concern with POCT is whether measure-
ments by nonlaboratory professionals (eg, nurses,
physicians) are accurate compared to measurements
by laboratory professionals. Studies have reported
that measurements obtained by nonlaboratory pro-
fessionals with the proper training can be as accurate
as those obtained by laboratory professionals.14,18
Measurements generally are accurate if operators
have been properly trained in quality assurance and
instruments are properly maintained.
There is additional concern that nonlaboratory
professionals may not have adequate understanding
or appreciation of the significance of quality control
and quality assurance for testing devices.2,17 Nonlab-
oratory professionals may not take adequate respon-
sibility for quality management and performance
enhancement, thereby potentially affecting patient
results. Therefore, it is important that the hospital
team (ie, physicians, nurses, medical technologists,
 Test Limitations
Linearity (mg/dL) † Chemistry Hct (%) pO2 (mmHg)
0-400 GO None None
None
20-600 GO 20-70 None
20-600 GO 20-70 None
20-600 GO 20-70 None
0-600 GO 25-60, adults None
25-65, neonates
0-600 GO 25-60, adults < 45, [Glu] > 150 mg/dL

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25-76, neonates
25-76, [Glu] ≤ 150mg/dL§
> 60, [Glu] < 150 mg/dL §
20-600 GO 30-55 None
20-600 GO 20-60 None
> 55, [Glu] < 300 mg/dL
10-600 GD 20-65, [Glu] < 200 mg/dL None
20-55, [Glu] > 200 mg/dL
10-600 GD 20-65, [Glu] < 200 mg/dL None
20-55, [Glu] > 200 mg/dL
† The equation to convert to SI units is: mmol/L = mg/dL 3 0.05551.
‡ Handheld device for measurement of glucose and ketones planned.
§ Hematocrit limits apply to neonate samples only.

respiratory therapists, and pathologists) know the
proper operating procedures and limitations of their
point-of-care testing instruments, whether they are
testing for glucose, electrolytes, blood gases, cardiac
markers, coagulation indices, or other analytes. Hos-
Table 3. Advantages and Disadvantages of Point-of-Care Testing
Advantages
Reduced therapeutic turnaround time of diagnostic testing
Rapid data availability
Reduced preanalytic and postanalytic testing errors

pital staff working with these instruments should be
familiar with and responsible for quality manage-
ment of their instruments, to ensure the reliability of
the patient test results.
Administrative staff (ie, nurse managers, coordi-
nators of point-of-care testing programs, and man-
agers of quality assurance programs) should keep
up-to-date with proficiency testing of operators of
point-of-care instruments at their facility as well as be
able to train new operators and assess operators’
Scientific Communications
Self-contained and user-friendly instruments
Small sample volume for a large test menu
Shorter patient length of stay
Convenience for clinicians
Ability to test many types of samples (ie, capillary, saliva, urine)
Disadvantages
Concerns about inaccuracy, imprecision, and performance
(ie, potential interfering substances)
Bedside laboratory tests performed by poorly trained
nonlaboratorians
Quality management/assurance issues and responsibilities

4
competence. Quality management deals with mea- not defined

sures taken by operators of point-of-care instruments
to ensure that instruments are accurate and perform-
ing optimally. Compromising the accuracy and preci-
sion for expeditious testing is not recommended.
Each medical institution should have its own quality
assurance committee that is responsible for the com-
petence of operators and for decisions about
expected performance standards of the entire testing
cycle. Additionally, operators must take necessary
measures to comply with regulations.
To regulate the performance of laboratory testing
(including point-of-care testing), the federal govern-
ment requires that each medical institution meet the
standards established by the Clinical Laboratory
Section
Cost of point-of-care testing compared with traditional
laboratory testing
Quality of testing is operator-dependent
Difficulty in integrating test results with hospital information
system (HIS) or laboratory information system (LIS)—
lack of connectivity
Narrower measuring range for some analytes
Improvement Amendments of 1988 (CLIA ’88).
Compliance with the Joint Commission on Accredi-
tation of Healthcare Organizations (JCAHO, Oak-
brook Terrace, IL) or College of American
Pathologists (CAP, Northfield, IL) regulations is vol-
untary. All medical institutions must comply with
state laws. These laboratory testing regulations help
to ensure the high-quality performance of the

J U LY 2 0 0 0 VO L U M E 3 1 , N U M B E R 7 L A B O R ATO RY M E D I C I N E 405
 Table 4. Preanalytic and Postanalytic Errors
Preanalytic errors
Mishandling and/or mislabeling of patient specimen
Contamination of specimen
Degradation of specimen due to delays in specimen
processing/testing and/or arrival at central laboratory
Postanalytic errors
Misreporting patient test results
Recording wrong patient test results
Lost data
Delayed reporting of critical results
Table 5. Cost Factors in Point-of-Care Testing
Supplies (eg, reagents, disposable cartridges, test
strips) and equipment
Training and retraining of instrument operators
Maintenance of instruments, including replacing
defective instruments
Additional labor on the part of nonlaboratorians
(eg, nurses) to run patient tests
New software that enables patient results to be entered
into hospital/laboratory information systems (HIS/LIS)
Troubleshooting instruments
Consultation services for instrumentation problems
Performing comparison studies of new instruments
and methodologies with existing instruments
Accreditation and proficiency testing fees
Duplication, repeated tests, verification, and validation
instruments as well the proper practice of diagnostic testing by
the operators.
Quality control compliance is one of the many quality
management monitors used routinely with POCT devices.
The Figure illustrates documentation of QC compliance rates
of critical-care operators and all other operators of point-of-
care devices at the University of California, Davis, Health Sys-
tem (UCDHS). As part of the quality assurance and
performance-improvement program at UCDHS, an e-mail
progress report is issued monthly to nurse supervisors of each
department by the pathology POCT manager. The report
provides an assessment of the overall QC compliance rate of
that department and compares the department’s performance
to the rest of the hospital. If the department compliance rate
falls below the rest of the hospital, a message in the e-mail
emphasizes the necessity for improvement to meet JCAHO
and CLIA guidelines. Performance has improved steadily with
the electronic broadcast approach.
Finally, there is growing debate about the cost-effectiveness
of POCT. It has been argued that the cost for POCT compared
to centralized laboratory testing may be less, more, or may
show no difference.19,20,21 Table 5 lists some factors that con-
tribute to the costs of POCT. While it appears that POCT may
be more expensive than laboratory testing, some argue that the
benefits of POCT—the small sample volume12 and short ther-
apeutic turnaround time7—could shorten the length of
patient stay or offset the costs of POCT—or both. POCT in the
operating room is cost-effective for hemostasis evaluation and
transfusion management.22 In some cases, such as rapid
406 L A B O R ATO RY M E D I C I N E VO L U M E 3 1 , N U M B E R 7
parathyroid hormone (PTH) testing for parathyroid surgery,
speed alone is crucial in saving operating room time and
reducing the length of hospitalization.23 Recent studies
demonstrated that point-of-care testing can reduce the length
of hospital stay24 and time in the emergency department,25 but
further study is needed to validate these results.
Technology of Whole-Blood Biosensors
Whole-blood analyzers currently use both electrochemical
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sensors and other methods (ie, optical sensors) for specimen
analysis. Electrochemical sensors are categorized as either
potentiometric or amperometric and include the ion-selective
electrode (ISE) and substrate-specific electrode (SSE). The
electrical conductance (impedance) sensor (ECS) is used to
measure hematocrit indirectly. Optical sensor technology
includes spectrophotometry, absorbance photometry, and
reflectance photometry. Table 6 lists analytes commonly tested
with these methods. Ion-selective electrodes operate by deter-
mining the electrical potential (relative to the reference elec-
trode potential) established by ions across selectively
permeable membranes. The difference in potential across the
membrane is logarithmically proportional to the specific ion
concentration (activity) in the blood.
The operation of a substrate-specific electrode is illustrated
when testing for glucose using the YSI 2300 Stat Glucose/Lactate
Analyzer. Glucose is oxidized with the catalysis of glucose oxidase
to form gluconic acid and hydrogen peroxide. Hydrogen perox-
ide subsequently becomes oxidized, and a platinum electrode
measures the current that forms. The current formed is propor-
tional to the glucose (substrate) concentration (molality). The
electrical conductance sensor operates by measuring the imped-
ance of the current flow in the sample. The impedance of the
current is measured by applying an alternating voltage across 2
or more electrodes in contact with the blood sample.
Features of Current Whole-Blood Point-of-Care
Analyzers and Glucose Meters
Notable features of point-of-care instruments include
expanded test options, shortened analysis time, reduced sample
test volume, and automated quality management. Current
instruments are able to measure up to 14 different tests per
sample of blood, compared to the 8 to 11 tests in previous gen-
erations. Many of the current instruments require a small
blood volume to perform a test—as little as 2.5 µL for a single
measurement on a handheld glucose meter, or as little as 40 µL
for 1 or 2 measurements, such as glucose and lactate, on a
whole-blood analyzer. The analysis time can be as rapid as 15
seconds for a single measurement, or 45 seconds for a multiple-
parameter test; hence, shortening the therapeutic turnaround
time. The latest whole-blood analyzers have the capability of
providing selective testing; that is, the operator may select the
tests to be performed, thereby eliminating unnecessary tests,
which can generate financial losses and waste patient blood.
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 100

90

80
Advanced quality management features also

Compliance Rate (%)

70
appear on the latest instruments. Most whole-
60
blood analyzers are equipped with automatic inter-
50
nal 1- and 2-point calibrations at various time
40
intervals ranging from every 15 minutes to every 2
30
hours. Some instruments have automatic or elec- All critical care units
All hospital areas
tronic QC (EQC). Automatic QC ensures that QC 20

testing is performed routinely at regular intervals. 10

The purpose of EQC is to test the electronics; that

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0

May 98

May 99
Nov 98
Aug 98

Aug 99
Mar 98

Mar 99
Sep 98

Sep 99
Dec 97

Jun 98

Dec 98

Jun 99
Apr 98

Apr 99
Jan 98

Feb 98

Jan 99

Feb 99
Oct 98
Jul 98

is, the internal and analyte circuits of the instru-
ment. However, EQC doesn’t validate the perfor-
mance of the test cartridges or of the operator. EQC
can help generate cost savings because it is conve-
nient, can be completed quickly, is reagentless,
requires only a reusable EQC card, and is a benefi-
cial feature that assesses the electronic measure-
ment cycle of the instrument. It is important to
realize that manufacturers of instruments with the
EQC feature do not recommend substituting EQC
for aqueous QC. Aqueous and electronic QC
should both be performed.
A QC “lockout” feature, when enabled, does not
allow the operator to perform any patient testing
unless quality control testing has been performed and
has satisfied the vendor-specified QC ranges. Other
lockout and security features include a password
option, which must be entered by a certified operator
before the instrument can be used for patient testing,
Jul 99
Month/Year
Quality control (QC) compliance rates. QC compliance rates are shown as a
function of time for critical care settings and all hospital areas at the University of
California, Davis, Health System from January 1998 through September 1999. The
line for all critical care units is based on 14 different critical care settings, including
intensive care units, the operating room, and the emergency department. The line
for all hospital areas is based on 57 settings. The graph shows progressive
performance enhancement after instituting electronic mail broadcasting.
thus ensuring proper usage of the instrument. Some
instruments require that proper patient identification
be entered before testing can proceed. This action
ensures proper documentation of test results.
Future of Point-of-Care
Instruments and Testing
An important issue to address now about POCT is
the accuracy, performance, and reliability of these

Scientific Communications
Table 6. Methods for Analyte Measurements
Method
Ion-Selective Substrate-Specific Electrical Conductance Analyte-Specific Optical
Analyte Electrode (ISE) Electrode (SSE) Sensor (ECS) Sensor (ASOS)
Ca++ Yes No No No
Mg++ Yes No No No
K+ Yes No No No
Cl– Yes No No No

4
Na++ Yes No No No

Section
pH Yes No No Yes
PCO2 CO2-sensitive buffer, No No Yes
with pH electrode
pO2 No Amperometric No Yes
Glucose No Yes No No
Lactate No Yes No No
Urea Nitrogen No Yes No No
Creatinine No Yes No No
Hematocrit No No Yes No
Hemoglobin No No No Multiwavelength
reflectance
Total CO2 Acid displacement, No No No
CO2-sensitive buffer,
with pH electrode
O2 saturation No No No Optical reflectance

J U LY 2 0 0 0 VO L U M E 3 1 , N U M B E R 7 L A B O R ATO RY M E D I C I N E 407

Test Your
Knowledge!
Look for the CE
Update exam on
Point-of-Care (004) in
the August issue of
Laboratory Medicine.
Participants will earn
4 CMLE credit hours.
408 L A B O R ATO RY M E D I C I N E
instruments for patient testing in the critical care set-
ting. More study is needed to examine the limita-
tions of these instruments and to resolve any
potential error sources (eg, interfering substances)
that may affect instrument performance. How-
ever, in regard to short-term advances with point-
of-care technology, we will see continued
expansion of test menus, shorter analysis time,
and reduced sample volume. For example, several
devices are now available for hemostasis testing at
the point of care,26 for other point-of-care ana-
lytes not listed in Table 1 (eg, ß-hydroxybutyrate,
therapeutic drugs, and drugs of abuse), and for
cardiac-injury markers (eg, troponin I, CK-MB,
and myoglobin). Several additional point-of-care
analytes are under development.
Additionally, POCT will be “connected” in the
near future. Test results will be downloaded and
recorded readily into the hospital and laboratory
information system (HIS/LIS). The first meeting of
the Connectivity Industry Consortium (CIC) on
POCT was held October 20, 1999, in Redwood City,
CA, to facilitate this process. The CIC members set a
goal of writing and publishing connectivity standards
for near-patient and point-of-care instruments by
the end of the year 2000.
Point-of-care testing undoubtedly will take a more
active role in critical care settings. It will be used more
for on-site diagnostic testing and trend monitoring of
patient conditions, due in part to the increasing per-
centage of critically ill patients in hospitals, the need for
shorter therapeutic turnaround time, and bidirectional
connectivity of transportable, portable, and handheld
devices. While POCT may not necessarily replace cen-
tralized laboratory testing, it is becoming an important
modality for improving patient care and outcomes.l
Acknowledgments
The authors would like to acknowledge Joan Bullock for her
contribution of information and insights into the Quality
Assurance Program at the University of California, Davis,
Health System, and thank the vendors for providing informa-
tion on their products.
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