Point of care testing: Mobilising critical care

August 2010

In critical situations, Point-of-Care Testing (PoCT) plays a crucial role by providing immediate diagnostic results. Besides, they are also smaller in size, simpler in design and easier to operate. With technological advancements these devices are now capable of providing accurate results at par with the actual laboratory testing. KTP Radhika Jinoy probes into the benefits and the latest advancements therein.

For many years, all large and small diagnostic testing procedures were performed only inside the central laboratory. But with advancements in technology and emergence of new testing devices, it is now possible to perform diagnostic tests just about anywhere – the patient’s bedside, inside a pharmacy, in a physician’s office, inside a patient’s home or any other non-laboratory site. This sort of testing is called PoCT. The main aim of PoCT is to facilitate convenient and immediate testing for faster results and quicker decisions pertaining to course of treatment.

Giving an insight on the benfits of this to the patients, Jitesh Mathur, General Manager- PMCC, US, HI, Philips Healthcare India says, “The Point-of-Care concept enables delivery of care at the point where a patient is. This eliminates the need of transporting the patient to various places in the hospital. Therefore, it reduces any chances of trauma, infections, etc and helps integrate all information, reports & data regarding the patient at one place. Hence, PoCT is very important in critical care.” Taking the thought further, V Raja, President & CEO, GE Healthcare, South Asia says, “PoCT has a very important role to play when it comes to patients being investigated in critical cases like accident, trauma, cardiac arrest, stroke, etc, who are mostly immobile. Technology can reach such patients at their bedside, rather than them being moved to the concerned departments. The quick results obtained via PoCT help to hasten up the treatment and emergency care given in the initial 20 minutes, which are the decisive moments in gauging the chances of survival in such patients. Hence, the PoCT plays an important part in saving lives.”

Importance of PoCT

Jitesh Mathur

Dr Dilip Kumar, Senior Consultant–Laboratory Medicine, Max Healthcare, points out, “For instance, in a hospital setting for a

Dr Rina Shah

diabetic patient, a blood glucose meter acts as a PoCT device, which takes less than a minute to give the result. Hence, treatment can be given immediately if the patient is suffering from any complications of the disease. These tests do not require much expertise and can easily be done by a technician, a nurse or a physician. Moreover, it requires only a single drop of whole blood, urine or saliva. Thus, PoCT aids rapid decision making, reduces triage time, decreases post-operative care time and minimises hospital beds occupancy.”

Advancements and evolution

Today, PoCT is acclaimed worldwide and finds a vital place in public healthcare. Due to this widespread popularity, PoCT devices have undergone many technological innovations and have evolved considerably. Dr Rina Shah, Consultant Pathologist, Godrej Memorial Hospital, asserts, “Due to advances in medical technology, PoC analysers now have prepackaged reagent systems, microprocessor controlled reactions & calibration, miniaturisation of components, simple quality control leading to increased accuracy and ease of operation.”

Innovative devices such as glucose monitoring systems that are minimally invasive or non-invasive, do not require any patient preparation and are likely to go a long way in promoting & popularising PoC technologies. Says Dr Ramkumar Raghupathy, Dean, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, “Improving and upgrading the analytical principles of PoC testing devices will assure better quality of the process.”

Validation is another area of improvement. Dr Suvin Shetty, Consultant Pathologist and Laboratory Co-ordinator, Department of Laboratory Medicine, Dr L H Hiranandani Hospital, explains, “The origin of PoCT dates back to around two decades. In the initial stages, validation of PoCT devices was a major challenge. PoCT devices have to be validated and the results that PoCT provides should be equivalent to the actual result obtained from a test performed in the central laboratory. With new technologies coming in, things have started to change. New and improved devices can provide more accurate results.”

V Raja, President & CEO, GE Healthcare, South Asia

Advanced features of PoCT devices

There are several PoCT devices available today, which combine features like portability, accuracy and precision, besides being

Dr Suvin Shetty, Consultant Pathologist and Laboratory Co-ordinator, Department of Laboratory Medicine, Dr L H Hiranandani Hospital

minimally invasive. Examples include, IntelliVue X2 and CX50 patient monitoring systems from Philips; VScan point of care ultrasound system and Mac India & Mac 400 portable ECG systes from GE Healthcare. Other point of care ultrasound systems include LOGIQ Book, LOGIQ E, Vivid i, Vivid e, etc, which are no bigger than a laptop. The portability of PoCT imaging devices and the capability to transfer images using the Internet is well suited for a country like India, owing to the lack of infrastructure and manpower to provide care to a large population living in rural areas. Also, modern high-end PoCT devices can enable early detection of chronic problems like cardiac diseases during primary check ups.

Roadblocks

According to Mathur, “The affordability issue is addressed through our solutions approach which allows hospitals and doctors to buy modular or scalable solutions based on actual need.” Another major challenge is the lack of standardisation, which prevents comparison of results obtained in different laboratories or operating rooms employing different devices. “At present, quality assurance is not very effective. Besides, there is a possibility of false positive or negative in few tests. Moreover, the use of new technology fails to find acceptability among senior doctors. Also, there is a possibility of misuse by patients,” remarks Dr Kumar.

Market scenario

Dr Ramkumar Raghupathy, Dean, G Kuppuswamy Naidu Memorial Hospital, Coimbatore

Despite roadblocks the PoCT market is all set for growth. Currently, there is a strong emphasis from the hospital segment on the use of PoCT devices, which is because of its high testing monitor potential. “The market looks good for the PoCT devices, however, manufacturers have to address the requirements of the users especially in dealing with emergency situations,” opines Raja. Adding to this Mathur says, “The market for PoCT devices is emerging as a major need in India. The market is currently growing at a rate of 20 to 25 per cent.”

Future prospects

In this situation, PoCT devices become the need of the hour. S Ganesh Prasad, Director – Ultrasound Business, GE Healthcare South Asia, says, “Technological inventions can play a critical part in bridging these huge gaps that stand in the way of the vision of a healthy India. Healthcare in India is poised for new dimensions with the introduction of modern PoCT devices. However, miniaturisation of technology is the need of the hour for providing rapid access to advanced healthcare for more people at reduced costs.” Experts predict that the future of PoCT devices is going towards even more compact designs and packing in further technology and networking features to use platforms such as mobile devices or Blackberry devices for enabling faster access to patient information and immediate care delivery.

PoCT will gain more popularity because of distinct advantages over conventional methods. Dr Kumar feels, “The future of PoCT will be good as the market will growlargely due to its huge advantages. With time, it would gain more acceptability among physicians. Also as technology advances, more tests can be carried out at the point of care, thereby further widening the spectrum of applications.”

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