Point of care testing in critical care.
POCT is rapidly expanding in today's critical care areas. Nurses need to be involved in the implementation and evaluation process of POCT at every step. Each institution must determine which bedside tests are indicated based on an in-depth analysis of test accuracy, positive clinical impact, and cost-benefit ratio. Generally speaking, the progress in technology over the last two decades has resulted in highly accurate tests used for POCT. However, accuracy of the test is contingent on correct calibration and correct usage by the test performer. Reduced TAT, particularly therapeutic time, is the major advantage to POCT. The clinician identifies the need for a blood analysis and within seconds to minutes has a measurement upon which to change or implement an intervention. For the critically ill patient this can potentially save lives and allow for rapid titration of medications or mechanical ventilation, as well as decrease intubation times and ICU length of stay. Reduction in blood loss for the patient is the second major advantage of POCT. POCT requires 2 drops of blood for analysis versus 3 mL or greater for a test sent to the laboratory for analysis. The cost-benefit examination needs to occur from many views. The cost of education, supplies, and personnel of POCT versus laboratory testing are a few key aspects. However, because different testing techniques exist, it is difficult to do absolute cost comparisons. In addition, cost savings of faster ventilator weaning or decreased ICU length of stay are also important factors to include. Lastly, costs are not just financial costs. In addition, clinicians should examine the cost to patients regarding comfort and quicker discharge. These are quality indicators from the patient's perspective. POCT offers many advantages, but surrounding the implementation of this technology is a multitude of questions that each institution must answer prior to undertaking a POCT program.
Schallom
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Surgical-Burn-Trauma Critical Care, Barnes-Jewish Hospital, Washington University Medical Center, St. Louis, Missouri, USA.
D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D008991:Monitoring, Physiologic / Q000191:economics / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D019095:Point-of-Care Systems / Q000458:organization & administration*; D015203:Reproducibility of Results