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The Promise of Bedside Point-of-Care Testing

Such testing may provide timely treatment with some limitations

Point-of-care testing may serve as part of a predictive, personalized, and pre-emptive approach to medicine, according to the National Institutes of Health (NIH).

ExecutiveInsight reports that the NIH believes point-of-care (POC) testing holds the promise of timely treatment for patients and improved health care delivery and reduced disparities for hospitals.

"Assuming it’s reliable, easy-to-use POC technology allows the pace of health care to happen more quickly,” said Dr. David Kaelber, chief medical informatics officer of MetroHealth in Cleveland. “In general, that's good because it should lead to quicker interventions, which leads to decreased lengths of stay in the hospital and avoiding hospitalizations or emergency department visits."

A 2010 article in Deutsches Arzteblatt International, "Point-of-Care Testing in Hospitals and Primary Care," credits miniaturization of lab instruments and procedures for an increased use of vicinity-based  testing, noting that "results are immediately available at the patient's bedside. This brings a time advantage, allowing results to inform urgent decisions about future diagnostic and therapeutic procedures."

"If the POC costs less than [the] non-POC test and is reliable, then that's a no-brainer. I'd be getting answers faster and cheaper. If my typical cholesterol test costs $50, but $30 at POC, that would save lots of money because I'm billing the payer less," says Kaelber.

Sarah Brown, associate medical director of the core laboratory at St. Louis Children's Hospital in Missouri, isn't so sure. Citing connectivity issues, she says: "POC technology is nearly there, but there are other components and they're not there.”

To deploy POC throughout an entire health care system, "Point-of-Care Testing in Hospitals and Primary Care" advises a cost–benefit analysis "because the introduction is costly and requires a certain amount of organizational work, especially for quality management. The potential medical and economic benefits should be assessed individually in each case," it states.

Kaelber says the decision to deploy POC testing "depends on your health care delivery model and what you should be doing. Like many areas, this is rapidly growing. It's not an area to put your head in the sand," says Kaelber, who foresees the potential of bedside testing to raise all-important hospital survey scores.

"It definitely helps with patient satisfaction, which health care systems are held accountable to these days. Patients leave with more answers. I think they like that. If you have POC testing, you have fewer questions."

But Brown says, "with the exception of genetic panels for infectious diseases, we rarely use POC to diagnose. We can get penalized for hospital-acquired and surgical-site infections and can use POC rapid diagnostic infectious disease panels before we discharge patients. So, I can see it in that area."

She adds, "POC has the potential to be overutilized. The more you test a patient, the more likely you get an abnormal result. From a patient safety and cost perspective, it needs oversight."

Her advice to hospital executives: "Be knowledgeable. POC is very powerful, has a lot of limitations, and is expensive. It should be approached thoughtfully. Listen to experts. Consult lab staff and think about logistics," she says.

Source: ExecutiveInsight, December 21, 2015.

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