Fleisher M, Schwartz M K
Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Am J Clin Pathol. 1995 Oct;104(4 Suppl 1):S18-25.
This study evaluates the premise that point-of-care or near-patient testing provides more effective medical care because laboratory turnaround time is reduced and, therefore, presumably the time before therapy begins is reduced. An accurate evaluation of this premise must compare the operation of a point-of-care laboratory and an alternative dedicated, centralized laboratory. Assessment of both laboratory operations with respect to turnaround time, costs and benefits, regulatory factors, and finally patient care outcome are all essential in reaching a conclusion. In this study, laboratory operations in a centralized urgent care laboratory were compared with those of a point-of-care satellite laboratory. Turn-around time analysis for whole blood (heparinized specimens requiring no centrifugation) and serum analytes were measured during a representative time period. Analysis of turnaround time considered both the preanalytic time, defined as collection to receipt of the specimen in the laboratory, and the analytic time component that accounts for receipt, processing, analysis, and reporting of the final data into the laboratory information system. The preanalytic component of the point-of-care satellite laboratory was also compared with the urgent care laboratory equipped with a rapid-transport specimen system. Turnaround time in the point-of-care satellite laboratory and urgent care laboratory equipped with a rapid-transport specimen system. Turnaround time in the point-of-care satellite laboratory and urgent care laboratory equipped with a rapid-transport system were comparable. In this analysis, staff requirements, ability to comply with regulatory requirement, and the increasing demand for a larger selection of tests needed urgently were considered. In a tertiary care medical center, such as the authors', a dedicated, centralized laboratory equipped with a rapid-transport specimen system provides better comprehensive laboratory service than does a point-of-care facility with limited capability.
本研究评估了即时检验或床边检验能提供更有效医疗护理这一前提，因为实验室周转时间缩短了，因此，推测治疗开始前的时间也缩短了。对这一前提进行准确评估必须比较即时检验实验室和另一个专门的集中式实验室的运作情况。从周转时间、成本与效益、监管因素，以及最终的患者护理结果等方面对两个实验室的运作进行评估，对于得出结论而言都是至关重要的。在本研究中，将集中式紧急护理实验室的运作与即时检验卫星实验室的运作进行了比较。在一个代表性时间段内，对全血（无需离心的肝素化标本）和血清分析物的周转时间进行了分析。周转时间分析既考虑了分析前时间，即定义为标本从采集到送达实验室的时间，也考虑了分析时间部分，这部分时间涵盖标本送达、处理、分析以及将最终数据报告至实验室信息系统的过程。还将即时检验卫星实验室的分析前部分与配备快速运输标本系统的紧急护理实验室进行了比较。配备快速运输系统的即时检验卫星实验室和紧急护理实验室的周转时间相当。在该分析中，还考虑了人员需求、符合监管要求的能力，以及对更多急需检测项目的日益增长的需求。在像作者所在的三级医疗中心，配备快速运输标本系统的专门集中式实验室比能力有限的即时检验设施能提供更好的综合实验室服务。
