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Abstract

The use of point of care testing (POCT) is becoming more widespread. However, it is often implemented without a comprehensive assessment of its reliability in routine clinical use or of the need for such technology in its intended setting. This study followed a step-by-step evaluation of POCT through the evaluation of the technology provided, assessment of the clinical impact and financial considerations for its use. Two prospective randomised controlled trials formed the basis of the study assessing existing analysers and novel technology. These were set in two critical care wards, the Coronary Care Unit (CCU) and the Intensive Therapy Unit (ITU), to assess the requirements of POCT in different settings. All patients admitted to the wards during the trial periods were randomised to POCT or central laboratory testing (CLT). The POCT analysers were found to have varying degrees of accuracy compared to the CLT, but were considered suitable for clinical use. Turnaround time was significantly faster for POCT than CLT, although TAT for an individual result is not necessarily the rate limiting step. No significant differences were found between the two groups for clinical impact, except in CCU where those patients identified for early discharge were found to have a reduced LOS (Mann Whitney U test: p = 0.0256). Cost analysis showed test costs were significantly higher for test costs for POCT than CLT, however, total hospital costs were reduced in the early discharge group. Differences were observed between the two wards indicating that POCT is not suitable for all sites. In CCU the availability of POCT had a significant impact on the management of the patients, whereas in ITU, no advantage over CLT was observed. It is essential for a full evaluation of POCT to be undertaken prior to implementation to assess the need and suitability of the technology for use in the setting for which it is intended and not just for one or two aspects to steer the decision.

Publication Type:	Thesis (Doctoral)
Subjects:	Q Science > QA Mathematics > QA75 Electronic computers. Computer science R Medicine > RA Public aspects of medicine
Departments:	School of Science & Technology > Computer Science School of Science & Technology > School of Science & Technology Doctoral Theses Doctoral Theses

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