Stacy E. F. Melanson

Point-of-care testing (POCT) has the potential to improve turnaround time, increase efficiency, decentralize diagnostics in rural and underserved communities, and advance health care in areas such as space and high-altitude wilderness. In many cases, POCT is accurate and simple to perform and produces results within minutes. However, its implementation can pose logistical and educational challenges, especially if testing does not easily integrate with the end users' workflow. Literature published on POCT between January 1, 2018, and December 31, 2018, was reviewed, and articles were selected for a more in-depth discussion. Relevant literature was grouped into the following categories: transfusion medicine, coagulation, glucose and diabetes, infectious disease and human immunodeficiency virus, emergency medicine, technological advances, and other.

This case highlights the importance of understanding the limitations of immunoassays in the emergent setting. The number of deaths due to drug overdose continue to rise, and many institutions rely on urine drug testing by immunoassay to support the diagnosis and management of patients presenting with potential overdose (1). Urine is typically the specimen of choice because drugs are present in higher concentrations and the collection process is noninvasive. However, urine results may not explain the …

Context.—: A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). Objective.—: To determine the impact of an interfaced EHR-LIS on laboratory processes. Design.—: We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. Results.—: The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P < .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P < .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P < .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. Conclusions.—: An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

Since the first articles published on point-of-care testing (POCT) over 2 decades ago, POCT has established itself as a vital and accessible tool for real-time diagnosis and monitoring of an increasing number of diseases. As such, recent focus has been placed on improving the performance of existing point-of-care tests, expanding utilization, and developing POCT for novel diseases where rapid results are imperative to triage and treatment, such as Ebola. The literature published on POCT between January 1, 2015, and December 31, 2015, was reviewed. Select articles are described and grouped into the following categories: hematology and coagulation, diabetes, cardiac disease, infectious disease and human immunodeficiency virus, emergency medicine, technological advances, and other.

Buprenorphine (BUP), a semi-synthetic opioid analgesic, is increasingly prescribed for the treatment of chronic pain and opioid dependence. Urine immunoassay screening methods are available for monitoring BUP compliance and misuse; however, these screens may have poor sensitivity or specificity. We evaluated whether the pretreatment of urine with β-glucuronidase (BG) improves the sensitivity and overall accuracy of three BUP enzyme immunoassays when compared with liquid chromatography–tandem mass spectrometry (LC–MS-MS). Urine samples sent to our laboratories for BUP testing (n = 114) were analyzed before and after BG pretreatment by cloned enzyme donor immunoassay (CEDIA), enzyme immunoassay (EIA) and homogenous EIA (HEIA) immunoassays using a common 5 ng/mL cutoff. Total BUP and norbuprenorphine (NBUP) concentrations were measured by LC–MS-MS as the reference method. Urine BG pretreatment improved EIA, HEIA and CEDIA sensitivities from 70, 82 and 94%, respectively, to 97% for each of the three methods, when compared with LC–MS-MS. While the specificity of the EIA and HEIA remained 100% after BG pretreatment, the specificity of the CEDIA decreased from 74 to 67%. Urine pretreatment with BG is recommended to improve sensitivity of the EIA and HEIA BUP screening methods.