Overdiagnosis of anemia or significant differences in electrolyte concentrations relative to central laboratory analyzers have been reported for POCT analyzers, whereas interchangeability was observed in others. Nevertheless, previous studies assessing the concordance of POCT with central laboratory testing have reported divergent findings. POCT provides an adequate solution to obtain immediate results at the bedside, as abnormal blood electrolyte or hemoglobin concentrations need to be promptly corrected for ICU patients. The primary objective of a blood gas analyzer (BGA) is to deliver accurate measures of blood gas levels (pH, pO 2, pCO 2) however, modern analyzers can currently measure additional parameters in the same blood sample, such as hemoglobin or electrolyte concentrations (sodium, potassium, chloride, and ionized calcium). Intensive care units (ICUs) have thus increasingly used POCT as a routine element of patient management, notably for blood gas analysis. POCT systems have been developed over the past few years and have enabled a wide range of tests to be rapidly and simply performed without using sophisticated central laboratory equipment. One of the major advantages of POCT is the reduction of the laboratory test turnaround time to rapidly treat the patient as appropriate. Point-of-care testing (POCT) can be defined as a rapid biological test near the site of care of a patient or at the bedside. We demonstrate that quality management focused on the preanalytical process and performed by the partners involved in the POCT can overcome these issues. We clearly demonstrate that an identical analyzer can provide results of varying quality depending on the local constraints of the ICUs. The improvement of the preanalytical process resulted in a substantial decrease of the bias for hemoglobin concentration measurements: −3 g/L in the 37-bed ICU. The quality approach was implemented in the 37-bed ICU and led to corrective actions that: (1) reduced the time for the POCT preanalytical phase (2) implemented a checklist to validate the preanalytical conditions (3) used technical innovations. However, biases for hemoglobin analyses were clearly affected by the preanalytical process: −3 g/L in the operating room, −5 g/L in a 10-bed ICU, and −19 g/L in a 37-bed ICU. Resultsīiases were clinically nonsignificant for potassium and sodium concentrations for all tested critical care units, relative to the reference method. A second comparison was performed on 278 paired blood samples in this unit. A quality improvement program was then implemented to improve the preanalytical POCT process for one ICU where there was poor agreement. The clinical significance of agreement was assessed using Bland–Altman plots. In three adult critical care units, 491 paired blood samples were analyzed for hemoglobin, potassium, and sodium concentrations by blood gas analyzers (identical reference) and the central laboratory. The aim of this study was to assess the reliability of results provided by point-of-care analyzers according to the organization of the care units and the preanalytical process. Most reported studies on POCT reliability have focused on analyzer performance rather than the preanalytical phase. However, previous studies comparing the concordance of POCT with central laboratory testing have reported divergent findings. Point-of-care testing (POCT) systems enable a wide range of tests to be rapidly performed at the bedside and have attracted increasing interest in the intensive care unit (ICU).
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