Near patient testing and pathology in the new millennium

Recently laboratories have tended to become more specialised and also centralised. Some process millions of samples a year, somewhat like a factory assembly line. High throughput, cost–effective automation (perhaps including the use of robotics), stringent quality assurance processes, computerisation with data storage and retrieval systems, and highly skilled monitored personnel are now common practice in many laboratories. Paradoxically, at the same time there has been a gradual growth in the decentralisation of laboratory tests for patient management, with test analysis being performed at the bedside, clinic, or by the patients themselves at home. This process has been broadly called “near patient testing” or NPT. Many terms have been ascribed to laboratory testing in sites other than centralised laboratories such as: alternative site testing, point of care testing, physician office laboratory testing, bedside testing, limited service laboratory testing, ancillary testing, out of laboratory testing, and near patient testing, to name but a few. However, in the United Kingdom NPT is popularly used, although the question arises of how near is near, and what about individuals who are not patients? The term “point of care testing” may be preferable, as this would include bedside testing, in vivo testing, physician office laboratory testing, and patient self testing.1 In a classic paper about 15 years ago, the basic philosophy behind NPT in the context of clinical biochemistry was described.2 New technologies now exist that have brought into being this prophetic message. Indeed, matters have now extended beyond clinical biochemistry to other pathology disciplines, including microbiology and haematology. This recent interest in NPT returns us to over 100 years ago when clinicians would taste their patients' urine at the bedside to help diagnosis diabetes mellitus, or would evaluate patients' body fluids with a microscope on the ward. ### TURNAROUND TIMES One of the main advantages of …