Point-of-Care Testing

Point-of-care testing (POCT) is a type of clinical laboratory testing conducted at or near the site of patient care. POCT provides rapid turnaround of test results, with the potential to generate results quickly, allowing for the implementation of appropriate treatment and leading to improved clinical or economic outcomes compared to laboratory testing. Traditional laboratory testing typically involves a multiple-step process that includes collecting samples from the patient at the bedside or the clinic, transporting them to a centralized laboratory, often located far away, and then subjecting the samples to several processing steps. The delay in treatment caused by the time-consuming traditional laboratory testing can hinder timely clinical decision-making. POCT addresses this challenge by bringing the laboratory to the patient. Portable and handheld testing devices enable healthcare professionals to perform rapid testing on samples, significantly reducing the time needed for medical decision-making. The concept of on-site or near-patient testing for blood analysis was initially explored in England during the 1950s and was referred to as near-patient testing. In the early 1980s, Dr Gerald J Kost introduced the term  after extensive research on the application of biosensors for monitoring ionized calcium levels in whole blood. The term  was subsequently defined as the testing at or near the site of patient care. Technological advances, including the miniaturization of electronics and improved instrumentation, have facilitated the development of increasingly smaller and more accurate POCT devices. Cutting-edge POCT integrates microneedles and microfluidics for improved comfort, speed, and accuracy. Essential features of point-of-care testing include simplicity of use, with reagents and consumables that remain stable and reliable during storage and use. Test results should be consistent with those obtained from established laboratory methods, and procedures must ensure safety for both patients and healthcare personnel throughout the testing process.  Various international guidelines define key attributes of POCT. The ASSURED framework, proposed by the World Health Organization, is one of the most well-known models, particularly for infectious disease diagnostics, such as those related to sexually transmitted infections. The acronym highlights that POCT should be affordable, sensitive, specific, user-friendly, rapid, robust, equipment-free, and deliverable to end-users. Affordability makes tests accessible to at-risk patients, whereas being equipment-free means they do not need complex tools. More recently, this framework has been updated to the REASSURED criteria, which keep all the main features of ASSURED but add 2 new aspects—real-time connectivity, which links tests with health information systems, and ease of specimen collection, supporting minimally invasive sampling. Together, these criteria serve as a complete standard for developing and implementing effective POCT solutions in diverse healthcare settings. The National Academy of Clinical Biochemistry has developed evidence-based guidelines for POCT, providing grading and recommendations to optimize the use of POCT based on scientific research and clinical evidence. Developing trends in POCT include the integration of artificial intelligence and machine learning in the execution and interpretation of lab testing, as well as the continued miniaturization of POCT devices. POCT guidelines generally emphasize the rapid results and cost-effectiveness of POCT, along with the importance of high sensitivities and specificities to support informed clinical decision-making.