Physician Office Testing

During the past decade, point-of-care testing (POCT) has gained increasing favor from clinicians. Increasing support from laboratorians has also become apparent, as pathologists and core laboratory managers have become involved in POCT management as technology advanced dramatically, to allow for accurate and precise near-patient testing, and regulatory mechanisms have been falling into place. One of the many laboratory management issues is to limit testing errors. Inspection and accreditation processes have been very successful in achieving this goal for clinical laboratory testing. Managers of POCT generally support similar scrutiny for their operations. In reviewing the impact of periodic inspection by the POCT manager for the POCT sites at Fletcher Allen Healthcare in Burlington, Vermont, the authors found that inspection correlated directly with laboratory error. During the 3-month period before the POCT staff was decreased 50%, the error rate averaged 2.0%. During a second period 5 months later, following suspension of POCT inspections by the POCT manager, the error rate averaged 2.7%. Finally, during a third period 6 months later, after the reinstitution of POCT inspections, the error rate averaged 1.1%. For the most recent 3-month period for which data are available, following 11 more months of POCT inspections, the error rate averaged 0.5%. These data emphasize that the challenges to management of POCT are the same as those for clinical laboratory testing, and indicate the need for measures for continual and methodical surveillance of all laboratory testing.