POC testing usually consists of waived tests performed by clinicians. They can be quite useful in:
(1) adjusting a medication (glucose and insulin, INR and coumadin)
(2) removing bottlenecks in high throughput areas such as the Emergency Room
When considering the cost of the program:
(1) clinician time to collect specimen, test and record result
(2) cost of the test, which is often much more expensive than the comparable test performed on a large analyzer
(3) wastage and theft of reagents
(4) competency assessment, which can be significant if the testing is performed by many clinicians
(5) need for multiple devices, including spares
(6) need for a computer interface for each device if applicable
There often is no additional reimbursement to cover these costs.
Operational problems with a POC program may include:
(1) A clinician asks an aid who has not been trained to performed the test.
(2) A test is performed with outdated reagents.
(3) Controls are not performed as required.
(4) Results are not recorded properly into the chart.
(5) The device is malfunctioning but the clinician performs the test anyway.
(6) Some people performing the tests will not take testing seriously (bad attitude).
(7) Enforcement of policies may be difficult if the manager does not take the program serously.
(8) A user bypasses a safeguard that is viewed as a nuisance.
Bottom line:
(1) In the laboratory the testing environment is better controlled, the number of people involved is smaller and tests can be done cheaper.
(2) Serious problems can exist in a clinical point of care program and go unrecognized.
