Strengthening Care

Vol. 19 • Issue 9 • Page 16

At The Bedside

Every day, clinical laboratories are faced with an expanding set of challenges in providing timely patient care. Staffing shortages, new technology and increasing demands for accountability from the healthcare industry mean that laboratory directors must routinely implement new patient testing protocols and data management techniques.

Point-of-care testing (POCT) is an important component of comprehensive testing in today’s laboratories. At Miami Children’s Hospital, our laboratory manages, integrates and centralizes POCT information originating from the intensive care units, operating rooms, emergency department (ED), off-site centers and air and ground transport to ensure a continuum of care. Implementation of POCT accelerates availability of critical test information that clinicians require to make rapid triage and treatment decisions.

Expanding POCT

For many years, our POCT program mostly involved bedside glucose and urinalysis monitoring. Our expansion for blood gases, electrolytes and basic chemistry analytes began with our hospital’s LifeFlight program to support patients transported to our hospital. The availability of blood gases and electrolytes is vital when transporting critically ill patients, particularly from distances like the Caribbean, Central and South America and other parts of the U.S.

Our LifeFlight program played an important role during the aftermath of Hurricane Katrina in New Orleans and more recently in Haiti following the catastrophic earthquake; POCT was important in supporting the transport of critically ill children from these regions. Subsequently, POCT was moved into key areas in the hospital: the intensive care units, operating rooms and ED.

Today, our centralized POCT program complements the clinical lab’s mission of providing timely and high-quality information for all patients throughout the hospital system. Integration of POC data with our laboratory information system (LIS) ensures the information is readily available to our clinicians throughout the hospital network. Additionally, the program is overseen by our POC coordinator and other members of the laboratory team. Their principle responsibilities are to manage and monitor staff training, quality assurance and control and equipment maintenance.


The management team at our laboratory dedicated considerable time to evaluate where POC technology was necessary and beneficial for patient care to justify broad implementation. Beyond the use in our LifeFlight program, we initially concluded that POCT would be of enormous value in all of the intensive care units and operating rooms. Next, we engaged stakeholders throughout the hospital network.

We realized that expansion of POCT would enable discontinuation of the stat lab without a reduction in staff since technologists in that area were reassigned to other sections in the lab. Our decision to discontinue conventional blood gas analyzers was in some respects the most challenging, in part because of inertia (major changes are not always easy even when justified), but also because of the level of comfort with the traditional blood gas analyzers. However, parallel studies proved unequivocally that the accuracy of blood gas analyzers and chemistry analyzers was comparable to POCT devices.

Furthermore, we emphasized to our staff that the role of the lab is to accurately and efficiently provide information to our clinicians and patients regardless of where the testing occurs.


With POCT, reliable results are generated in as quickly as two minutes. In many circumstances rapid availability of vital information leads to more effective treatment intervention in critically ill patients when every minute counts. This perspective is supported by comments I’ve received from many of my physician and nursing colleagues who have indicated that POCT affords them the opportunity for real-time feedback of vital laboratory parameters when caring for their patients.

Since establishing a POC program more than 12 years ago, we have seen tangible benefits. Not only has POCT accelerated availability of critical diagnostic test information, but centralization of the program and integration of the data with the LIS helps us comply with regulations, adhere to quality control and assurance best practices and provide the hospital with accurate data for fiscal purposes. Prior to the program, results from many bedside tests such as glucose levels were only transcribed in the patients’ charts and never captured in our LIS. This represented lost revenue for the hospital. With an electronically integrated POCT system, the hospital is now able to capture this revenue, generated in the main campus, off-site facilities or even our LifeFlight program.

Dr. Melnick is chief of the Department of Pathology and Clinical Laboratories, Miami Children’s Hospital.