Blood analysis at the point of care: issues in application for use in critically ill patients.

Major changes in the healthcare environment have increasingly forced hospitals to reconsider their operative structures to maintain cost competitiveness. These changes have included restructuring and numerous hospital mergers, and they have forced hospitals to examine ways to improve operational efficiency. Nowhere in the hospital is this truer than in the critical care areas, where costs are highest, and one of the places where process improvements can be made is in the laboratory analysis. Data indicate that laboratory analysis comprises about 43% of the data used by critical care clinicians to make clinical decisions. The more quickly these data can be provided to the clinicians, the more likely they are to have an impact on the patient's care.Point-of-care testing (POCT) in critical care is one way of simplifying the laboratory analysis process so that laboratory data are more readily available to clinicians. A close collaborative relationship with the clinical laboratory can allow a robust POCT to be implemented in critical care that meets the needs of both the clinical laboratory and the critical care areas. When implemented appropriately, a POCT program in critical care can provide rapid and accurate test results, can be fairly simple to maintain, and can be cost effective. However, successful implementation requires a new set of skills for critical care nurses including knowledge of the laboratory regulatory issues, a commitment to training, recertification, and a quality improvement program related specifically to POCT. Several studies have shown that laboratory turnaround time can be reduced through the implementation of a POCT program. However, at this writing, no studies have linked this decrease in turnaround time to improved patient outcomes, although there are some data to support a decrease in iatrogenic blood loss with the use of POCT. Although the use of POCT in critical care has some distinct benefits, clearly, outcome studies need to be conducted to assess the true impact of POCT on the care of patients who are critically ill.