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Hemoglobin A1c Testing and Diabetes Management
By: Jessica Pawlak, Michael Sweatt, Catherine Cahill, Ralph Ito, December 21, 2018, MLO

The Diabetes Research Institute Foundation has estimated a 50 percent increase in the number of people living with diabetes mellitus in the United States over the past decade. With more than 400 million people living with and managing diabetes worldwide, the ability to accurately diagnose and track patient management is a growing need. The diagnosis of diabetes mellitus uses a combination of measurements: fasting serum glucose levels, presentation of symptoms, two-hour plasma glucose levels during a glucose tolerance test, and hemoglobin A1c (HbA1c) levels.2 Current patient management includes diet, exercise, medication, daily monitoring of blood glucose, and HbA1c monitoring.

Mayo Clinic Laboratories emphasizes the value of controlling glucose levels to prevent long-term complications such as retinopathy, neuropathy, and cardiovascular disease. However, solely measuring and monitoring blood glucose levels has some limitations as the test only measures glucose levels at the time of testing and it relies on the patient to consistently test their levels at home, using a point-of-care device. To address these limitations and provide a broader indication of long-term glycemic control, HbA1c testing is used. It is typically performed in a laboratory setting and the test indicates the patient’s average levels of blood glucose over the past 8 to 12 weeks. The NGSP, originally called the National Glycohemoglobin Standardization Program, supports the American Diabetes Association’s recommendations that patients who are meeting glycemic goals be tested for HbA1c twice a year, while patients not meeting glycemic goals or patients with changes to therapies be tested every three months. The American Diabetes Association sets a normal patient at < 5.7 percent, prediabetes patients at ≥ 5.7-6.5 percent, and diabetic patients at ≥ 6.5 percent HbA1c. Read more >

Rapid PCR Rules as Labs ready Flu Arsenal
December 2018, CAP Today, Anne Paxton

With the memory of the 2017–2018 “high-severity” influenza season fresh in mind—49 million cases, 960,000 hospitalizations, a marginally effective vaccine, 79,000 deaths—clinical laboratories have been bracing for the customary annual surge in emergency room, outpatient clinic, and physician office influenza test orders. Although flu admissions have been rising somewhat, it is too soon to know how the season will play out, but laboratories are hoping for a season closer to average.

Avoiding a repeat of last year’s travails—lengthy turnaround times, supply shortages, and the need to triage patients for testing—is a must, many laboratory directors say. “We had difficulty keeping up with last year’s demand. It was extremely time-consuming,” says Mary Kay O’Connor, national laboratory director at Summit Health Management, the management arm of the Summit Medical Group, an 800-provider practice on the East Coast. Read more >

The Power of Internal Audits and Site Inspections for Improving Point-of-Care Testing
By Vikram Palamalai, PhD, November 2018, Clinical Laboratory News

At MetroHealth, a county-wide healthcare system based in Cuyahoga County, Ohio, the volume and complexity of our point-of-care testing (POCT) have increased rapidly. In the past, we had a decentralized POCT system in which individual testing centers held independent CLIA licenses.

While this was a reasonable strategy when POCT was available only at a few sites, the mushrooming dissemination of this modality led to a situation in which our POCT coordinators could provide only initial training and guidance with technical issues but were not involved in overseeing individual testing areas.

Though qualified medical staff were designated as directors, oversight was lacking at some sites. The limitations of this decentralized system came into sharp focus during an accreditation visit that found significant shortcomings, primarily due to the fragmented nature of the POCT program. Read more >

Improve Point-of-Care Glucose Measurements with Staff Outreach
By Uyen B Chu, PhD and Tiffany N Heady, PhD, Medical Lab Management, October 2018

Bedside glucose testing using strip technologies constitutes the highest test volume in most hospital-based point-of-care testing (POCT) programs. A 2010 study estimated that in health care settings, 51 percent of POCT involves bedside glucose meters using strip technologies. However, since the 2014 published warnings from the US FDA and CMS (both since retracted) on the potential erroneous results produced by glucose meters in critically ill patient populations, managing the off-label use of bedside glucose testing presents a significant challenge for hospital POCT programs.

Issues Exacerbated in Critically Ill
Originally designed as an over-the-counter product for managing glucose levels in diabetic patients, glucose meters are now used on virtually every hospital patient regardless of medical condition or the limitations specified in the manufacturer’s package insert. Glucose meters were initially... Read more >

The Pros and Cons of Point-of-Care Testing

versus Laboratory Testing
By Lisa-Jean Clifford, MLO

Point-of-care testing (POCT) is used to refer to any patient testing that is done at, or near, the actual location of the patient.

 

But how does software enable these testing capabilities, and are the results comparably applicable to the results in the lab?

Read more >

The Laboratory’s Role in Guiding the

Best Use of Point-of-Care Testing
By Kim Futrell, MLO

Continued growth in point-of-care testing (POCT) is certain as technologies improve and the benefits of POCT are realized in value-based healthcare. However, POCT is a diverse and complex area of laboratory testing, riddled with the challenges inherent to multiple locations, disparate devices, and non-laboratory trained operators. To reap the advantages POCT has to offer, POCT programs can greatly benefit from laboratory intervention and oversight. Laboratory professionals who approach POCT oversight as a team endeavor, keeping end users’ workflows and backgrounds in mind, can be instrumental in helping reap the potential benefits that POCT offers in patient care.

POCT’s renewed value instigates continued growth
The rapid turnaround time (TAT), convenience, and mobility of POCT—in specific patient scenarios—can speed clinical decision-making and treatment decisions and simultaneously help avoid other unnecessary procedures and associated risks. POCT’s rapid results can help optimize which patients receive advanced care, and improve patient understanding and engagement, giving POCT a more important role in patient-centered care. Read more >

Create a Strong Lab Team Through Recruiting
By Milly Keeler, MT(ASCP), CLC(AMT), CCCP, Medical Laboratory Management

No matter how much money is spent on sophisticated laboratory instrumentation, a lack of qualified, well-trained personnel will undermine the laboratory’s success at every turn. In fact, well-trained and skilled laboratory personnel are the single greatest determining factor of operational success. That said, recruiting and retaining new laboratorians can be difficult, time consuming, and expensive.

Managing risk is more important than ever in this litigious age and as experienced laboratory staff members are retiring faster than new employees are able to fill those positions, many laboratories are experiencing significant increases in workload and work-related stress. These circumstances are a breeding ground for potential mistakes, increased costs due to overtime and temporary workers, and for the cessation or abandonment of improvement projects. Therefore, a concerted effort should be invested in how the laboratory is bringing new staff on board. Read more >

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Last updated: 11/09/2018 Questions or corrections: editor@pointofcare.net. © 2016  BACK TO TOP