The Institute for Quality Management in Healthcare (IQMH) held a conference in Toronto last week called “The Future of Point-of-Care Testing—A Healthy Debate!”
“Because of the ever-greater use of POCT in clinical settings throughout Canada, IQMH has organized this conference regularly in recent years,” stated pathologist Gregory J. Flynn, MD, CEO of IQMH. “It is one of the few clinical laboratory programs that brings together experts and users to discuss issues of quality, clinical relevance, and the challenges in using point-of-care testing in support of patient care.”
One of the more controversial topics discussed was point-of-care testing in rural areas.
Quinte Health Care (QHC) uses point-of-care instruments in the emergency departments (ED) of the majority of their hospitals. “We serve an area that is primarily rural. We have four emergency departments and three of these are in very small hospitals,” stated Mark Hudgins, Point-of-Care Charge Technologist at QHC. “Because of the limited volume of specimens generated by these EDs and hospitals over the years, we found it uneconomical to operate a standard clinical laboratory in each of these sites and we turned to POCT as a solution.”
The QHC Prince Edward County Memorial Hospital (PECMH) in Picton, Ontario, has 15 inpatient beds and closed its clinical laboratory to support the ED entirely with POCT. Its ED serves 19,000 patients annually, and the budget for the clinical lab was $850,000. After setting up point-of-care testing in a space next to the ED in 2009, the cost of this lab testing dropped to $150,000—an 82% reduction.
To read about the other hospital’s successes click on the article title above.
Theranos Founder and CEO, Elizabeth Holmes made an announcement highlighting some dramatic changes in the company this past week.
Theranos will shut down all its clinical labs leaving hundreds of employees working in these labs without a job. Out of the total 790 employees working for them, they have laid off 340 people. This totals to around 43% of the employee strength.
According to Holmes, this drastic change took place after spending months on assessing their strengths and addressing their weaknesses. Theranos will close down its facilities in Arizona, Pennsylvania, and California. This is in order to focus on rebuilding its practices after multiple regulatory investigations. Moreover, a new executive team will lead the work. Various agendas taken up by this team are obtaining FDA clearances, pursuing publications in scientific journals and building commercial partnerships.
The American Society for Clinical Pathology (ASCP) has added five recommendations for laboratory treatments and tests that physicians and patients should question.
The test and treatments join a list of 10 previous recommendations, issued as part of the Choosing Wisely initiative, managed by the American Board of Internal Medicine (ABIM) and Consumer Reports.
"As ASCP continues to expand our recommendations, we expect to see increasing higher quality, appropriate care with lower costs, and more effective use of our medical laboratory resources and personnel," Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)CM, chair of ASCP’s Effective Test Utilization Subcommittee and a past president of ASCP, said.
They recommended that physicians:
- Test for lipase when they suspect acute pancreatitis instead of amylase;
- Do not routinely biopsy the sentinel lymph node or perform other diagnostic tests when assessing for early, thin melanoma, as testing does not increase survival;
- Use breath tests or stool antigen when evaluating for H. pylori instead of serology;
- Do not request an expanded lipid panel, which includes nuclear magnetic resonance and particle sizing, when screening for cardiovascular disease; and
- "Do not perform fluorescence in situ hybridization (FISH) for myelodyplastic syndrome (MDS)-related abnormalities on bone marrow samples obtained for cytopenias when an adequate conventional karyotype is obtained."
Related article: When Less Is More for Patients in LaboratoryTesting