Point-of-Care Testing (POCT)

Point-of-Care Testing (POCT)

• Defined as medical testing at or near the site of patient care
• According to College of American Pathologists (CAP), POCT is “diagnostic tests designed to be used at or near the site where the patient is located, that do not require permanent dedicated space, and that are performed outside the physical facilities of the clinical laboratories”
• First reported in papyrus documents in 1550 B.C. by Egyptian physicians using ants to determine glycosuria in patients suspected of having diabetes mellitus

Characteristics of POCT

• Also known as near patient testing, bedside testing, ancillary testing, alternative testing, and decentralized testing
• Widely used ASSURED criteria for rapid tests by WHO:
  • Affordable
  • Sensitive
  • Specific
  • User-friendly
  • Robust and rapid (results available in less than 30 minutes)
  • Equipment-free
  • Deliverable to those who need the test

Benefits of POCT

• Improve quality of patient care
• Enhance efficiency of patient care
• Increase physician and patient satisfaction
• Improve patient education
• Decrease liability risk
• Minimize burden at central level

POCT Devices

• Use small amounts of unprocessed specimens
• Use finger sticks over phlebotomy
• Types of tests:
  • Blood gas
  • Electrolytes
  • Pregnancy
  • Cardiac
  • Infectious disease testing
• Portable, enhancing the possibility of “bringing lab to the patient”
• Current estimates: POCT encompasses nearly one-third of in vitro diagnostic testing

Advantages of POCT

• Reduced turn-around time
• Improved patient morbidity and mortality
• Reduction in hospital admission
• Improved interaction between patient and carer
• Reduction in clinical visits
• Improved cost of care
• Reduction in administrative work associated with test requesting and reporting

Staff Requirements

• Anyone can perform POCT with proper training and documentation of competency
• Laboratory professionals can assist in POCT programs

Ideal Requirements for POCT Devices

• First result in a minute or less
• Portable instruments with consumable reagents cartridges
• Single-operating protocol
• Capability of direct specimen analysis (whole blood, CSF, urine) / non-processed sample
• Simple operating procedure
• Flexible test menus
• Results that meet analytical specifications that are “fit-for-purpose” and with accuracy and precision comparable to central lab
• Built-in/integrated calibration and quality control
• Ambient temperature storage for reagents
• Low instrument cost
• Built-in regulatory record keeping
• Results provided as hard copy, stored, and available for transmission

Components of POCT Devices

• Bar code identification systems
• Sample delivery devices
• Reaction cell sensors
• Control and communications systems
• Data management and storage
• Manufacturing requirements

Sensor Technologies Used in POCT Instruments

• Optical or electrical signal chemosensors
• Biosensors

Types of POCT Devices

• Single-use qualitative strip or cartridge and/or strip devices
• Dipsticks (single-pad devices)
• Complex strips (complex pad with several layers, semi-permeable membrane)
• Immunosensors (biological sensors with recognition agent an antibody that binds to an analyte)
• Lateral flow immunoassay for troponin T
• Single-use quantitative cartridge and strip test

Explore the concept of Point-of-Care Testing (POCT), which involves medical testing at or near the patient's location. Learn about its definition, history, and significance in healthcare according to the College of American Pathologists (CAP). Discover how POCT has evolved since its first reported use by Egyptian physicians in 1550 B.C.