Ensuring the Quality of Point-of-Care Testing in a Large and Decentralized Ambulatory Care Setting

Am J Clin Pathol. 2017 Oct 1;148(4):336-344. doi: 10.1093/ajcp/aqx081.

Abstract

Objectives: In this project, we assessed the breadth, quality, trends, and outcomes of point-of-care (POC) testing and regulatory compliance in 200 University of California, Los Angeles (UCLA) Health system outpatient clinics.

Methods: We retrospectively extracted clinic POC test orders, results, and e-prescription data from the UCLA electronic health record over a 1-year period.

Results: Over 100,000 total tests were performed, encompassing 10 POC tests. Initially, 40% of clinics did not have complete licensure, but after implementation of the POC team, this metric improved to 100% licensure within 6 months. Most clinics used two or fewer POC tests, resulted fewer than 200 tests per year, and performed little to no external quality control measures. Our data analytics approach showed that peak POC testing occurred in January 2015, driven by influenza and urinalysis testing, and that both the testing and resulting clinical decision making do not routinely follow society guidelines.

Conclusions: This decentralization of laboratory testing presents challenges to ensuring quality POC testing. Optimization and analysis of informatics data allow for the identification of POC test utilization trends, areas of improvement for clinical workflows, and increased education on national guidelines.

Keywords: Ambulatory laboratories; Bedside testing; Electronic health record; Group A strep; Influenza; Informatics; Point of care.

MeSH terms

  • Ambulatory Care Facilities / standards*
  • Humans
  • Los Angeles
  • Point-of-Care Testing / standards*
  • Quality Assurance, Health Care*
  • Quality Control
  • Retrospective Studies