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.”

Pathologist Gregory J. Flynn, MD (above), Chief Executive Officer of the Institute for Quality Management in Healthcare (IQMH), based in Toronto, Ontario, Canada, chaired last week’s conference on point-of-care testing, which took place on October 3-4 and was titled, “The Future of Point-of-Care Testing – A Healthy Debate!” (Photo copyright: Dark Daily.)

Pathologist Gregory J. Flynn, MD (above), Chief Executive Officer of the Institute for Quality Management in Healthcare (IQMH), based in Toronto, Ontario, Canada, chaired last week’s conference on point-of-care testing, which took place on October 3-4 and was titled, “The Future of Point-of-Care Testing – A Healthy Debate!” (Photo copyright: Dark Daily.)

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:

Albumin CK Lactate TCO2
Alk Phos Creatinine Magnesium TP
ALT CRP Mono Test Troponin
Amylase D-Dimer Occult Blood Urea
AST eGFR Phosphate Uric Acid
bHCG GGT Potassium Urinalysis
Blood Gas    Glucose Rapid Strep Group A   Urine Drug Screen 
Calcium   HbA1c Group A Urine Pregnancy Test
CBC INR Sodium
Chloride Ionized Calcium   Tbil

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:

Alere Triage

Abaxis Piccolo Xpress

Abbott i-STAT

Nova StatStrip

Roche h 232 

Roche Coaguchek XS Pro 

Siemens Clinitek Status Connect 

Siemens DCA Vantage 

Siemens RAPIDPoint 500 

Sysmex pocH-100i 

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
Related Information:

IQMH Symposium 2016: The Future of Point-of-Care Testing – A Healthy Debate!

ISO 15189 Medical Laboratories Understanding the Four Components of a Quality Management System

Pathologists in Canada Address Handling and Use of Tissue Specimens for Clinical Diagnostic Purposes at IQMH Conference in Toronto