Point-of-care testing (POCT) is a term that refers to medical diagnostic testing that is performed at or near the site of patient care, such as in a hospital ward, a doctor's office, a home, or a remote location. POCT can provide fast and convenient results that can help clinicians make timely and informed decisions for diagnosis, treatment, and monitoring of various diseases and conditions. POCT can also improve patient satisfaction, reduce costs, and save lives. 1 2
Historically, POCT faced challenges and risks with health care providers trading speed for quality and reliability. Variation in device capabilities, operator experience, and environmental controls have been shown to cause errors. Device malfunction, operator error, sample quality, environmental factors, and interference from other substances can reduce introduce errors, which can lead to inaccurate or invalid results. 3 4
Current POCT devices must be evaluated carefully to ensure reliable results are produced and to protect patient health. Health care providers have faced a number of burdens when choosing to perform tests in clinic rather than sending to outside reference labs including implementing and maintaining appropriate quality management systems and practices.
Quality management for POCT includes evaluating device validation with gold standard tests, training in clinic staff to reduce operator errors, establishment of quality control and assurance programs, as well as ensuring equipment is maintained and kept in good repair. 3 4
Our consideration of test accuracy should be more dynamic and extend beyond routine measures, such as correlation coefficients and Bland Altman plots. It should also include evaluation of cost, patient compliance with testing and treatment, and patient retention. Rapid diagnosis and treatment could improve patient outcomes by simply reducing barriers associated with the added time and expense of seeking diagnostic testing through reference labs.
While health care providers must evaluate tradeoffs between POC and reference lab testing for current technologies, research and development should strive to meet ideals established by WHO for point of care testing. The World Health Organization established ideals for point of care tests which fall under the acronym of ASSURED. ASSURED tests are affordable, sensitive, specific, user friendly, rapid and robust, equipment free, and deliverable to end users. Many new technologies in development will close the gap in quality between POC testing and reference lab techniques, including digital holographic microscopy, surface acoustic wave biosensing, and artificial intelligence. Use of a single consumable for a single sample provides the ability to efficiently run quality control and quality assurance tests for each sample. Lab automation reduces or even eliminates errors associated with busy health care providers being distracted from test processes. Artificial intelligence allows efficient and reliable capture of information for interpretation by healthcare providers immediately or when time allows without interruption of checking behind less experienced technicians. In clinic diagnostic analyzers are becoming more reliable with reduced operator training and machine maintenance.
Conclusion
POCT is a valuable and innovative technique that can improve the quality and efficiency of health care, by providing rapid and convenient test results at the point of care. The burden of quality management to ensure accuracy and reliability of test results will decrease with new technological advances. Health care providers will be able to choose patient centered care without sacrificing accuracy or cost. 3 4
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