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• We describe the structure and scope of a POCT program in a large hospital. • The POCT team consists of 2.9 staff for a cost of $0.80 per test. • POCT tests comprise 10.8% of all tests performed in our institution. • Multiple POCT vendors are used as no vendor can supply all of our POCT needs. Point-of-care testing (POCT) is an important component of hospital-based and ambulatory laboratory testing. Despite its importance, there is relatively little in the peer reviewed literature describing the details of successful POCT programs. Administrative records and test volumes from the Massachusetts General Hospital were compiled using POCT middleware (Telcor) and the hospital information system (Epic). Financial data was derived from vendor contracts and the hospital budget management system. Our POCT management team consists of 2.8 medical technologists and 0.1 medical director with an annual labor cost of $458,000 ($0.80/test). The team oversees quality and regulatory compliance for 143 testing sites. POCT constitutes 24 tests with an annual volume of over 573,000 tests (10.8% of all tests performed). Regular site inspections utilizing a compliance checklist with mandatory remedial action plans are employed. This approach has reduced inspection citations from 3.17 per testing site to 0.27 citations. The average cost of POCT tests is $1.89. POCT is widespread in our institution and comprises a significant percentage of the total test volume. A dedicated POCT team combined with regular site inspections using a comprehensive checklist facilitates regulatory compliance and quality testing. [ABSTRACT FROM AUTHOR]

Abstract: Background: Management of point-of-care testing (POCT) continues to present challenges. The use of site inspections by POCT coordinators has been a mainstay for maintaining regulatory compliance in POCT although this process is labor intensive. Improvements in device design and the use of POCT data management systems have improved the ability of hospitals to manage POCT programs. Given these developments, using regular site inspections to ensure regulatory compliance of POCT may be less relevant than in the past. Methods: We implemented an expanded POCT site inspection checklist modeled after the requirements of the Joint Commission. The checklist included categories not specifically related to POCT such as the environment of care and safety. Results: The average number of deficiencies per site in 2011 was 2.37 (range 0–10) out of a possible 42. Only 18% of site inspections produced no citations. In contrast in 2010 the average number of deficiencies per site was 3.17 (out of a possible 32) and only 8.7% of sites had no citations. The difference in the number of deficiencies per site was significant (t-test two tailed p=0.04). The most frequently cited deficiencies (24.2%) related to safety followed by maintenance of proper procedures and documentation of competency assessment. Conclusions: Despite improvements in many POCT devices and data management systems, regular site inspections are still required to identify regulatory deficiencies and improve testing quality. The use of an expanded site inspection checklist will identify many areas for improvement that are not specifically related to POCT alone. [Copyright &y& Elsevier]

Abstract: Introduction: There have been many reports describing individual POCT technologies but there are no recent studies describing the organizational scope and impact of a POCT program. Methods: Our menu of POCT tests has increased to 26 and the test volume to 664,287 tests/year equivalent to 14.5% of the volume of the central core laboratory. POCT is performed in nearly all inpatient units and in a variety of outpatient settings. Results: Cumulatively 84.6% of the test volume and most testing sites can be accounted for by 4 traditional tests (bedside glucose testing, fecal occult blood, dipstick urinalysis and activated clotting time). Most POCT tests are not performed because of a true medical necessity but rather to improve the efficiency of clinical operations. Conclusion: We are experiencing a significant increase in requests for new POCT tests. Unlike established high volume conventional POC tests, these new requests originate from specialized services seeking to improve the efficiency of clinical operations. [ABSTRACT FROM AUTHOR]

Background We evaluated the effectiveness of an expanded point-of-care (POCT) site inspection checklist over an extended 8-y period. Methods A retrospective review of site inspection deficiency reports in a large academic medical center from 2010 to 2017 (year to date). Results There was a significant decrease in the number of cited deficiencies per site/inspection from 2010 (3.17) to 2017 (0.27) ( p < 0.001). The percentage of sites without deficiencies steadily increased from 2010 (8.7%) to 2017 (80.7%) ( p < 0.001). The most common citation was documentation of competency assessment followed by results documentation and annual procedure review. Conclusions Regular inspections of sites performing POCT are necessary to maintain regulatory compliance. Over time significant improvements in compliance are achievable. [ABSTRACT FROM AUTHOR]

Abstract: Background: Measurement of creatinine and calculation of the estimated glomerular filtration rate (eGFR) are widely employed to identify patients with chronic kidney disease who are at risk for contrast induced acute kidney injury and nephrogenic systemic fibrosis. However, patients may present for radiologic studies without a recent creatinine/eGFR necessitating cancelation of the study or performance of the scan without contrast. Both of these approaches are suboptimal. Methods: We implemented a rapid whole blood point-of-care (POCT) creatinine test (iSTAT, Abbott Point-of-Care) in our radiology department and assessed the impact on clinical operations. Results: Over a 7-month period a total of 3087 creatinine tests were performed. Overall 5.3% of patients presenting for scans (441/month) did not have a recent eGFR. An audit of 1month of creatinine/eGFR values showed that 74% were normal permitting the scan to be performed without further consideration. Of the abnormal values 74% were performed with contrast and 26% without. Of note 78% of patients with an abnormal eGFR had a normal creatinine value. The cost of the POC test was $10.06 compared to a cost of $5.32 (including phlebotomy) for a creatinine performed in the central laboratory. The added incremental cost for the POC test was therefore $4.74. Conclusions: Determining the cost effectiveness of the rapid test is extremely challenging because the analysis would need to take many complex factors into consideration including the effect on workflow in the radiology department, the clinical impact of more timely scans, the clinical and financial consequences of performing scans with or without contrast and the impact on revenues complicated by differential reimbursement rates and payor mix. However, given the benefits of the test on radiology operations and on the quality and timeliness of care it appears that the POCT test is cost effective and improves clinical operations. [Copyright &y& Elsevier]

Abstract: Background: Point-of-care laboratory testing (POCT) offers reduced turnaround time and may facilitate medical decision-making and improve clinical operations. However, there is very little published data concerning the impact of POCT on patient satisfaction. Methods: We implemented POCT for hemoglobin A1c, lipid panel and comprehensive metabolic panel in a primary care practice and monitored patient satisfaction with on-site testing using an anonymous survey. Results: A total of 97 surveys (65% response rate) were reviewed. On a scale of 1 (poor) to 4 (excellent) the mean response to the question “Compared with your past experiences of physician office visits that did not have on-site testing please rank your overall level of satisfaction with today's office visit” was 3.96. In 34 surveys a free text comment was included which was uniformly very positive. Conclusions: Our study strongly indicates a high level of patient satisfaction with on-site POCT in a primary care setting. [Copyright &y& Elsevier]