As POC testing grows, so do risk of errors, quality
Today testing of patients at the point of care (POC) accounts for 25% of all testing, and these portable assays are increasing their penetration into medical practice at rapid rate of 12% each year.
Yet along with the growth comes an increasing risk of errors that adversely affect quality of clinical decision-making and patient safety.
« Already healthcare is not as safe as it should be, » said Dr Christian Falk of Zurich University Hospital in Switzerland, citing a death rate due to medical errors that places hospital are among the top 10 leading causes of death.
« If a Boeing 747 crashed each week, this would be the equivalent of deaths in the healthcare system for the United States or Europe alone, » he said.
POC testing brings great benefit to healthcare with rapid results for glucose levels, cardiovascular monitoring, or even simple pregnancy tests, he said.
Yet these tests are increasingly performed by non-laboratory personnel and subject to errors such as inapporpriate testing, excessive testing, inconsistent specimen collection, mistimed tests or critical resuts that are either not recognized or not documented.
An especially wide area for simple error with serious consequences is mis-identification at any of the stages in a process that includes pre-analysis, analysis and then post-analytic results .
At his hospital in Zurich, Dr. Falk has studied the variations in patient identifications taken from a bed number, a patient medical record, or a patient wrist band, which is rare in Zurich.
The workflow error potential is great, he said, at a large medical center when it turns to « rush hour » at the blood analyzer with unreadable bar codes and syringes stacked on paper toweling marked with bed numbers.
Dr. Falk, who made a career transition from the hospital's lab to its info systems believes POC testing should follow a similar path.
He has conducted a pilot program in Zurich that integrates POC test results with the patient medical record through the health information system.
A test profile is created by zapping the bar codes on the ID badge of the healthcare worker performing the test, on the POC test device being used, and then on a patient identification badge.
This profile is bundled in a central process analyzer with the test results and simultaneously sent to the patient medical record and the POC test result device.
He said the system is not completely stable at the moment, nor is it scalable, meaning it is not yet ready to be deployed across the entire university hospital campus.
Yet it is an essential first step, he said, in approaching POC testing the same as other critical healthcare functions, such as the medical device supply chain with single unit doses.
He also said that increasingly, the manufacturers of POC tests need to support embedded data transfers in their applications to integrate with web-based reporting portals at hospitals.
18.11.2009
