BACKGROUD: Point of care testing (POCT) is defined as any testing that is conducted outside the clinical laboratory. More and more hospital departments installed POC devices without any consultation or involvement of the laboratory department. The purpose of this work was first to list all POCT conducted in the Rambam hospital, secondly to insert a procedure managing insertion of new devices, and third to plan and insert a quality control and training program supervised by the laboratory department.
METHODS: A list of the all the departments where POCT were conducted was made. Then we decided to concentrate first on blood gas instruments and glucometers. To ensure results harmonization and standardization, all the blood gas instruments were replaced and now all the blood gas devices across the all hospital, included in the laboratory are similar or from the same series. All the glucometers are similar. The department's instruments are connected to the LIS and to software that can summarize the performances of all the devices. Procedures included the responsibility of the laboratory department, the biomedical engineering unit and outpatients department as well as quality control frequency were written.
RESULTS: 8 blood gas analyzers are dispersed in 6 different departments and there is about 80 glucometers all over the hospital .All POCT results are released via the LIS to the patient sheet. Quality control included harmonization in blood gas devices is performed. Three levels of quality control for glucose are performed once a month and if it is not made the department staff cannot perform any glucose test before quality control performance. The laboratory supervises the quality control performance and gives a technical assistance when it is required. The laboratory is also responsible to cancel sample when a mistake in patient identification occur and to record it.
Finally, before the insertion of new devices, a discussion included the direction of the department, direction of the laboratory department and the direction of the biomedical engineering unit is conducted to examine the necessity of the device in the department.
CONCLUSION: The involvement of the laboratory department improves the quality assurance of the POCT and the ability to control tests performed outside of the laboratories. The next steps will be insertion of external quality control for TEG instruments in the operating room and internal quality control for the few urine strip devices.