The current and future status of critical care testing and patient monitoring

Ex vivo and in vivo biosensor-based systems for patient monitoring now augment in vitro point-of-care testing, a paradigm currently in the explosive phase. As new technologies arise, so do opportunities for laboratory professionals. First, the laboratory consultant or clinical pathologist can contribute substantially to our understanding of temporal optimization and the role of diagnostic testing in optimizing diagnostic-therapeutic processes. Clarification of these facilitates wise selection of alternative testing modalities, test clusters, and instrument formats. Second, the laboratory professional is a natural member of a performance team that can help optimize outcomes and assure the quality of point-of-care testing. Explicit site-specific performance criteria for accuracy, precision, response time, and test clusters are essential and can only be established and accomplished jointly with clinicians. Third, clinical integration requires practice guidelines and care paths. These can help determine how, when, and where point-of-care testing should be implemented. Finally, global outcomes optimization calls for the input of those professionals who are most familiar with the economics of diagnostic testing, the challenges of point-of-care testing, and the best clinical benefits of in vitro, ex vivo, and in vivo biosensor-based systems in critical care and other settings.