Point-of-care testing (POCT) is a bedside test that can help clinicians identify changes in the condition of patients with acute and severe conditions at an early stage and save patients' lives. The Expert Consensus on the Application Management of Point-of-Care Testing in Acute and Critical Illness (2024) involves the clinical application of personnel management, equipment management, and data management, providing more comprehensive specifications and guidance for the application of POCT in acute and critical illness.
Clinical Question 1
What does POCT include in acute and severe disease?
Recommendation 1: It is recommended to set up POCT testing items for qualitative and quantitative indicators of blood gas analysis, electrolytes, inflammatory markers, coagulation function, myocardial injury markers, some blood biochemical indicators, urinalysis, pregnancy indicators, pathogen detection, drug abuse and acute poisoning in the emergency department and intensive care medicine department (Table 3)(1A).
Clinical Question 2
Which patients need POCT in the emergency department?
Recommendation 2: In acute and critical care departments, POCT is suitable for patients who need dynamic observation, mainly including: cardiac arrest, severe trauma, severe cardiovascular and cerebrovascular diseases, severe respiratory diseases, serious infections and infectious diseases, acute complications of diabetes, poisoning, liver and kidney insufficiency, some children, the elderly and pregnant women, and patients who need emergency preoperative evaluation (1A).
Clinical question 3
Does the POCT require a multidisciplinary committee?
Recommendation 3: A strict POCT quality control system and management system need to be achieved through multidisciplinary cooperation (1A); The multidisciplinary committee can help standardize the management of POCT, improve the accuracy and reliability of POCT results, and reduce the error of results (1A). Standardized and efficient POCT requires the participation and cooperation of administrative departments, laboratory departments, equipment departments, full-time POCT personnel of various clinical disciplines, and network software platform managers (Figure 1)(1A).
Clinical question 4
How to carry out standardized POCT training and effective qualification certification for medical staff?
Recommendation 4: The instructor of POCT training should be a laboratory analyst with certification qualifications, and the instructor should formulate corresponding training plans, effect feedback, quality control plans, etc. (2B); Interactive training is often more effective in POCT training, and a key point to ensure the quality of training is the effective communication and interaction between laboratory instructors and operators (1B); POCT training content is divided into pre-analysis, in-analysis, and post-analysis training, with a focus on operational safety and accuracy of analysis results (2B); It is necessary for POCT managers to implement a long-term training quality assessment program to ensure that operators are qualified POCT qualifications (1B).
Clinical Question 5
How to perform routine maintenance of POCT equipment?
Recommendation 5: POCT equipment is mostly high-tech precision instruments, and should be placed in a suitable location in strict accordance with the instructions (1B); POCT instruments need to be managed, maintained, cleaned and calibrated regularly, and damaged and expired instrument components (1A) replaced in a timely manner; When the POCT instrument fails, it should be marked and repaired in time (1B); Users of POCT instruments should be trained and authorized (1A).
Clinical Question 6
What is the POCT operation process?
Recommendation 6: The POCT operation process includes three stages: pre-analysis, analysis and post-analysis, and sample collection and processing are important links in the pre-analysis stage (2B); Proper use of PPE and corresponding operating procedures is essential to protect workers and ensure the accuracy of testing (2B); Proper disposal of samples and waste must be carried out in accordance with the laws, regulations and certification requirements regarding the disposal of clinical waste after POCT (2B).
Clinical question 7
How to standardize the management of POCT data?
Recommendation 7: POCT should have a standardized data management and quality control system, and use the corresponding medical information system to process the data (1A); The inspection result information of POCT should contain the complete content of the inspection report, and the operator qualification information and equipment information should be updated in the system in real time (1A); The POCT of the out-of-hospital emergency "120" should be connected to the hospital system through the network to realize remote and real-time patient information management and reading (1B).
Clinical Question 8
How are POCT adverse events handled?
Recommendation 8: POCT adverse events or "reportable events" must be communicated to the holder and reported to the monitoring body within the prescribed time frame, depending on the type of event (1A); Adverse events in POCT were mainly caused by factors such as equipment failure, operation errors, sample problems, environmental factors, errors in interpretation of results, errors in clinical decision-making, communication problems, etc. (1B); Adverse events should be managed according to the POCT Adverse Event Management Procedure (1C).
Clinical Question 9
What are the quality control indicators of POCT?
Recommendation 9: Define key quality control indicators for different POCT projects (2B); Common POCT performance monitoring indicators are mainly the monitoring of some key quality control indicators before, during, and after test analysis (2B).
Clinical question 10
Should POCT be included in a national standard at a certain level or class?
Recommendation 10: The national standard for the implementation of POCT in mainland China is the "GB/T 29790-2020 Requirements for Quality and Capability of Point-of-Care Testing" (1A) issued by the Standardization Administration of the People's Republic of China in 2020.
Source: Emergency Medicine Branch of Wuhan Medical Association. Expert consensus on the application of point-of-care testing in the management of acute and critical illness (2024)[J]. Chinese Journal of Critical Care and Emergency Medicine,2024,36(09):897-909.