Ontario’s Institute for Quality Management in Healthcare convened the conference to help advance the effective use of point-of-care-testing by clinical laboratories
DATELINE—Toronto, Ontario, Canada: Interest in point-of-care testing (POCT) is strong in Canada. Evidence of that comes from a crowd of more than 240 clinical laboratory professionals and in vitro diagnostics (IVD) vendors who attended the “The Future of Point-of-Care Testing—A Healthy Debate!” conference here last week.
The meeting was organized by the Institute for Quality Management in Healthcare (IQMH). Based in Toronto, IQMH provides the ISO 15189 accreditation services used by medical laboratories in Ontario to meet the province’s lab licensure requirements. IQMH also handles lab accreditation for several other provinces.
“Because of the ever-greater use of POCT in clinical settings throughout Canada, IQMH has organized this conference regularly in recent years,” stated pathologist Gregory J. Flynn, MD, CEO of IQMH. “It is one of the few clinical laboratory programs that brings together experts and users to discuss issues of quality, clinical relevance, and the challenges in using point-of-care testing in support of patient care.”
Point-of-Care Testing Lowers Costs in Rural Settings
No better example of how POCT is gaining favor is the example of Quinte Health Care (QHC) in South Ontario. “We serve an area that is primarily rural. We have four emergency departments and three of these are in very small hospitals,” stated Mark Hudgins, Point-of-Care Charge Technologist at QHC. “Because of the limited volume of specimens generated by these EDs and hospitals over the years, we found it uneconomical to operate a standard clinical laboratory in each of these sites and we turned to POCT as a solution.”
According to Hudgins, the first facility to adopt an extensive POCT test menu in support of its emergency department (ED) was the QHC North Hastings Hospital (NHH) in Bancroft, Ontario. This happened in 1999. NHH has 13,000 ED visits annually and it has six beds. It had been sending its clinical laboratory tests to a private lab at a cost of $20,000 per month. After establishing a POCT program in a space next to the ED, the cost of lab testing dropped 25%, to $15,000 per month.
The QHC Prince Edward County Memorial Hospital (PECMH) in Picton, Ontario, has 15 inpatient beds, and was the next hospital where the decision was made to close the clinical laboratory and support the ED with POCT. Its ED serves 19,000 patients annually, and the budget for the clinical lab was $850,000. After setting up point-of-care testing in a space next to the ED in 2009, the cost of this lab testing dropped to $150,000—an 82% reduction.
Just four years later, Trenton Memorial Hospital (31 beds) in Trenton, Ontario, became the next hospital where the clinical laboratory was closed and, instead, POCT was used to serve the 32,000 patients visiting its ED in 2013. Again, the savings were substantial. The clinical laboratory was spending $1.2 million each year, but it cost only $220,000 to do the needed testing with POCT.
That left just Belleville Memorial Hospital, which, at 206 beds, is the largest hospital in the QHC health system. Located in Belleville, Ontario, its ED serves about 38,000 patients each year. At this hospital is a core laboratory that includes blood banking, microbiology, and histology. This lab serves the non-critical testing needs of the three other hospitals within the QHC system.
The point-of-care testing service at the previous three hospitals is capable of performing the following medical laboratory tests:
|Blood Gas||Glucose||Rapid Strep Group A||Urine Drug Screen|
|Calcium||HbA1c||Group A||Urine Pregnancy Test|
Hudgins spoke about the specific point-of-care testing systems that his clinical laboratory network used to perform the above menu of tests. The instruments are:
How Bias in Point-of-Care Testing Sways Results
Similar sessions on the topic of point-of-care testing were delivered over the two days of the conference. One example was the presentation of Martha E. Lyon, PhD, DABCC, FACB, Clinical Biochemist at Royal University Hospital of the Saskatoon Health Region. Her talk was titled, “Assessing Quality of New POCT Tests: Applying Lessons Learned from POCT Glucose to POCT Troponin.” Lyon spotlighted how bias in POCT testing would influence test results in ways that could possibly give clinicians an inaccurate understanding of the patient’s condition. In turn, this could contribute to misdiagnosis or selection of inappropriate therapies.
Overall, the two days of sessions provided insights into how the Canadian healthcare system is using point-of-care testing. It is certainly progressive to have health systems such as Quinte Health Care, where small rural hospitals have emergency departments that are supported by an onsite POCT capability, while relying on a larger hospital laboratory in the region for non-critical testing.
The fact that the oldest of these POCT arrangements date back to 1999 demonstrates that POCT can be a workable and cost-effective solution in such settings as Quinte Health Care.
Your Dark Daily Editor,
Robert L. Michel