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Who's Who in Point-of-Care Testing...

How long have you been involved in the POCT field and in what capacity?

I have been involved in POCT for over a decade as the co-director of the stat laboratories at the Mayo Clinic in Rochester, MN.  All POCT oversight is managed through the 3 POC Coordinators that are part of these laboratories.

Please tell us which kinds of POCT you have in your institution and the approximate volume of that testing (either per month or per year).

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Our facility is rather unique in that the common approach to providing POCT is through the laboratory.  There has not been widespread adoption of POCT by nursing for two reasons:

• We have stat labs in the hospitals that provide basic testing with a turnaround time of 15 minutes or less.

• Nursing has preferred not to deal with the logistics of JCAHO and CAP compliance due to the large number of personnel they have.   Even bedside glucose testing is performed by our team of phlebotomists.

As a result, our implementation of this testing has been very focused – we design our test delivery system based on the user’s needs and we explore a variety of options.  

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What are some of the biggest changes you have seen in POCT during the time you have been involved in this field?

Please answer this from a global perspective as well as from the changes experienced within your own institution.

I believe that the one of the biggest changes I have witnessed has been the gradual acceptance, by laboratorians, that POCT is a legitimate tool in patient care.  In the early days, we were all very skeptical of both the technology and its clinical utility.  Over the years, we have seen the technology become more mature and some positive clinical outcomes being identified.  At times, we still need to temper the enthusiasm of our clinical colleagues for POCT, but I think that all of us have a much more reasoned approach today.  POCT is one of the tools in our patient care toolbox to be used in the appropriate institution-specific situations.

Another very important development over the years has been the establishment of point of care coordinators.  These individuals have served as critical liaisons between the laboratory and the patient care providers.  The communication and networking that they are involved in, both within their facilities and nationally, have been essential in the evolution of POC technology and management.  The laboratory is no longer a faceless entity that provides test results; its expertise and role in patient care is evident.

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Are you involved with a POCT Committee within your institution and if so, what types of issues are commonly discussed during those meetings?

I am currently chair of our institutional committee that is responsible for POCT.  The committee reviews and approves requests for new POC tests and new service areas.  Although test performance data is reviewed, the primary determination is usually based on clinical need and patient outcome.  The committee also determines whether the test should be considered screening or definitive.  Compliance plans are reviewed and approved.

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Can you discuss a POCT initiative that you personally have witnessed that has turned into a positive outcome for either the institution or POCT in general?

This could be a PI plan, an evaluation of a product, or any type of process that has changed the way in which your institution addresses POCT.

There are a number of situations where POCT has been beneficial for the patient: outpatient INR testing for the Thrombophilia Center, intraoperative coagulation testing to guide transfusion therapy, blood gas and electrolyte testing for code situations, just to name a few.  The process that is going to change the way we do things the most is the broad application of process control, data management and connectivity.  Given the vast amounts of information that we all must deal with, electronic movement and management of the data is critical to our future success – growth in POCT will be limited without it.  However, process control is the key – we need to use technology and build processes that both eliminate error and minimize rework in order to ensure positive patient outcomes.  I have seen this begin with our bedside glucose program and it needs to be expanded to other types of testing as well.

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Who's Who Home

Paula J. Santrach, M.D.
Mayo Clinic, Rochester, MN

• Co-Director, Hospital Clinical Laboratories

• Director, Laboratory Services (Phlebotomy)

• Director, Vascular Access Services

• Consultant, Division of Transfusion Medicine

Doctor Santrach received her medical degree from the University of Minnesota in Minneapolis.  Her post-graduate training included a residency in Anatomic and Clinical Pathology at the University of North Carolina, Chapel Hill, and a fellowship in Transfusion Medicine at the Mayo Clinic.  She is certified in Anatomic Pathology, Clinical Pathology and Blood Banking/Transfusion Medicine by the American Board of Pathology.  She is a member of the College of American Pathologists, American Society of Clinical Pathologists, American Association of Blood Banks, and the American Association for Clinical Chemistry.  She is a fellow in the National Academy of Clinical Biochemistry and the current chair of the Point of Care Testing Division of the AACC.