Contributing lab leaders: Barbara Goldsmith, PhD, FACB
An increased reliance on point of care testing (POCT) in recent years has led many healthcare organizations to appointing coinciding coordinators. The role ensures quality managements system relative to testing, making certain that such services outside of the core laboratory not only meet the highest standards around quality control and efficiency, but also maintain compliance with state and federal regulations, as well as the expectations of the various accrediting agencies. It's an important job in a high-stakes environment, and one that will only become more important in the future as health care systems continue to expand care activities and outpatient care. Point of care testing is also widely referred to as bedside and or remote testing close to where the patient is located. Any type of testing that isn't done in the laboratory is included within this category.
With that in mind, we asked Barbara Goldsmith, PhD, FACB, Chair of Medical Laboratory Sciences and Biotechnology at Thomas Jefferson University Hospital and director of the organization's point of program, for her thoughts on the challenges care coordinators face in managing the influx of requests and ways their employers might better support them. Here's a look at what she had to say.
The biggest issue the testing coordinator and clinical staff struggle with most involves the unrelenting and continuously growing stream of new requests for testing services among the patient population, Goldsmith says. Such requests, in her experience, come in “almost daily" if not even more frequently, and each one requires a close look and in depth analysis of the particular circumstances, along with a decision based on technical and financial feasibility. “If you don't have connectivity," for example, “it limits your ability to offer certain tests and testing systems at specific locations," Goldsmith says. Staff in this area who lack the right resources, access to the current healthcare innovation & technology or even the formal backing from the C-suite—can quickly become overwhelmed, Goldsmith adds.
Thomas Jefferson Hospital recently settled on an advantageous two-pronged approach to point of care coordination that helps Goldsmith do her work more efficiently and effectively. First, she says, they developed a point of care “justification form" that must be filled out and completed as part of the process for any testing request. A point of care steering committee consisting of representatives from other departments across the organization was also created as an additional step in improving the process. The collaboration that takes place across disciplines with the implementation of the steering committee allows for improved solutions and seamless care testing programs. When someone comes to their coordinator with a POCT request now, that person submits a form and schedules a meeting with the committee, knowing he or she will need to make a valid and clear case to key stakeholders. “It's, 'We need this and this is why, and this is what it will cost,'" she explains. If it's determined they have the resources to support the new testing service and they will improve patient care within quality assurance standards, chances are the request will be granted. But either way, Goldsmith says, this “vetting process" allows all stakeholders and parties involved to make a well-informed decision and prevents POCT where it may not be warranted.
More populations on a larger scale are able to be served with POCT, as the very function is expedited, faster, more convenient service that can take place outside of the lab. As health disparities continue to rise, access to such testing works towards eliminating that concern overtime. POCT has been adopted by many regions across the world with the goal of care expansion.
In the end, Goldsmith says, the point of care poc coordinator must weigh the needs of the institution and its clinicians and patients against the technical, regulatory, and logistical challenges associated with testing itself. “The goal is to maintain quality, good practices and competency [when testing takes place] outside the medical laboratory," she says. When a point of care coordinator is empowered by an employer to limit those testing services to the places where they can really make a difference, the energy can be shifted toward places it's needed most. Yes, Goldsmith admits, an empowered point of care coordinator may ultimately cause adoption of POCT to slow down, but that's better than rushing to add testing services that aren't necessary, and it's better for the industry overall. While the need for point of care testing increases, quality assurance also remains a key factor in effectiveness to make sure individuals are receiving the best treatment possible, especially since this type of care is taking place outside of a laboratory.