An ongoing concern among our laboratories is how to ensure that bedside or remote laboratory testing is of the same quality as that performed in-house.
Technological advances have resulted in an explosion in the number of tests that can be performed outside the laboratory setting; locations include the operating room, the nursing station , bedside, and nursing homes, to name a few. More than ever, the laboratory must be proactive in monitoring this, if quality care is to be maintained. This means that all Point of Care (POC) testing personnel must be properly trained (and the training documented) and have their competency periodically assessed, even if all their testing is waived; all instruments involved should be used in accordance with manufacturer’s requirements with quality control, calibration, and maintenance records monitored; and test results verified as to accuracy and (if the patient has been previously tested) consistent with a patient’s history. Don’t forget to monitor reagent storage and handling as well. Utilization of split sampling and proficiency testing is also recommended for monitoring quality.
Many laboratories, mindful that POC testing may be performed by non-laboratory staff, often have a staff tech responsible for monitoring this testing, acting as both a liason to the laboratory , as well as a technical resource for the POC testing staff. This is an important responsibility, as feedback from the field to the laboratory is needed to identify potential communication problems, complaints, and the needs of both patients and staff.
In this new era of the Affordable Care Act and PCMH, the same standards now apply to POC testing as to in-house laboratories: the need for efficient test utilization; the importance of interfacing remote test results with all laboratory testing on that patient; and ensuring that all healthcare providers have the same access to these results as they would for in-house testing. New generations of POC instruments have interfacing capabilities.
There is even talk of using Smart Phone technology for performing certain tests (such as by reading indicator strips) and interfacing these results with the patient’s database. I can almost see the vision of the original Startrek infirmary where Dr. McCoy diagnosed his patients with the use of a Medical Tricorder.
The bottom line is that there should be no difference in the quality of patient care provided by the laboratory, whether performed within the confines of the laboratory itself, or anywhere else. Ultimate responsibility lies with the laboratory administration and staff.