Automated approaches to rapid-response testing. A comparative evaluation of point-of-care and centralized laboratory...

This study evaluates the premise that point-of-care or near-patient testing provides more effective medical care because laboratory turnaround time is reduced and, therefore, presumably the time before therapy begins is reduced. An accurate evaluation of this premise must compare the operation of a point-of-care laboratory and an alternative dedicated, centralized laboratory. Assessment of both laboratory operations with respect to turnaround time, costs and benefits, regulatory factors, and finally patient care outcome are all essential in reaching a conclusion. In this study, laboratory operations in a centralized urgent care laboratory were compared with those of a point-of-care satellite laboratory. Turn-around time analysis for whole blood (heparinized specimens requiring no centrifugation) and serum analytes were measured during a representative time period. Analysis of turnaround time considered both the preanalytic time, defined as collection to receipt of the specimen in the laboratory, and the analytic time component that accounts for receipt, processing, analysis, and reporting of the final data into the laboratory information system. The preanalytic component of the point-of-care satellite laboratory was also compared with the urgent care laboratory equipped with a rapid-transport specimen system. Turnaround time in the point-of-care satellite laboratory and urgent care laboratory equipped with a rapid-transport specimen system. Turnaround time in the point-of-care satellite laboratory and urgent care laboratory equipped with a rapid-transport system were comparable. In this analysis, staff requirements, ability to comply with regulatory requirement, and the increasing demand for a larger selection of tests needed urgently were considered. In a tertiary care medical center, such as the authors', a dedicated, centralized laboratory equipped with a rapid-transport specimen system provides better comprehensive laboratory service than does a point-of-care facility with limited capability.