Regulatory compliance for point-of-care testing. A perspective from the United States (Circa 2000)

Regulatory guidelines concerning point-of-care testing have had a major impact on the development and evolution of these technologies. Beginning with mandates under CLIA '88, hospital accreditation organizations have developed guidelines for the management of point-of-care testing to ensure quality testing. Over the past decade, most hospitals have learned to manage these new technologies as part of the laboratory quality assurance program. Issues concerning regulatory compliance continue to influence the development and use of point-of-care technologies providing opportunity for continuous quality improvement and improved patient care.

POCT regulatory compliance: what is it and how does it impact you?

Point-of-care testing (POCT), ancillary testing, bedside testing, and near patient testing all refer to the same thing--a form of testing that enables caregivers to determine results of lab tests at the bedside or near a patient on the floor. Performance of this type of testing has increased dramatically in the past several years. Why? There are several reasons. First, many clinicians want results Stat. They want to know immediately where the patient stands as far as blood glucose results, electrolytes, pregnancy tests, hematocrits, and ACTs, to name just a few. Physicians and nurses want to be able to make decisions quickly based on patient results and do not want to have to wait for the answers. Second, many vendors have been releasing better, simpler, more efficient devices that meet the needs of the caregiver by providing lab results in a timely manner. Third, regulatory bodies are recognizing and embracing this type of testing and are creating more complex checklists for compliance when performing these tests. This article focuses on the regulatory component of POCT to educate and familiarize individuals with an overview of the regulatory/accrediting bodies enforcing compliance in the hospital setting.

[Quality control of DNA testing in hereditary diseases]

The laboratories performing diagnostic studies regarding hereditary diseases and the specialists providing hereditary counselling are housed in clinical genetic centres. The laboratories are subject to the Special Medical Performances Act and have had licenses from the Ministry. The DNA diagnostic laboratories united in the National Committee on DNA Diagnostics, engaged among other things in quality control. The large number of tests requested and the dramatic consequences for the patient and his relatives necessitate high quality standards. The laboratories made a division of labour for analysis of most disorders, in order to acquire and maintain expertise in spite of rarity of most hereditary diseases. For adequate handling of requests for DNA diagnostic tests, it is important that the patient material be sent directly to the laboratory specialized in the disorders in question, for the request form to be filled out completely and for the patient data to be stated on the blood tube. A regularly updated review of the DNA diagnostics in the Netherlands can be found on the website: http://www.unimaas.nl/ approximately LOD/lod.htm. This list indications per centre and information such as required material and maximal results deadlines.

How to defuse compliance time bombs. Part 2: Six hypothetical allegations. Panel discussion

In the second and final part of this series, a panel of legal experts discusses more hypothetical allegations against a fictional laboratory, including billing for additional indices, using expired reagents, and falsifying the results of employee competency tests. Learn how to handle these dilemmas before they explode into full-blown legal violations.

Requirements for accreditation by the College of American Pathologists Laboratory Accreditation Program

The College of American Pathologists Laboratory Accreditation Program expects a participant laboratory or laboratory section to be able to demonstrate that it is in compliance with the Standards for Laboratory Accreditation. The program expects laboratories to demonstrate that they are continually taking steps to identify and correct deficient areas and improve performance, in compliance with the Clinical Laboratory Improvement Amendments of 1988 regulatory requirements, particularly those pertaining to proficiency testing performance, and participating as inspectors in the accreditation process.

The role of the medical laboratory technologist in drinking and driving cases. Part 2: The use of hospital alcohol results as evidence and providing testimony in court

Medical laboratory technologists routinely conduct alcohol analyses for medical purposes, however, in certain circumstances the results are used legally to determine a driver's Blood Alcohol Concentration. The technologist who performed the analysis may subsequently be required to provide evidence in court. The primary areas of interest to the court in these cases are: the type of swab utilized, the continuity of the blood sample, the method of analysis, the margin of error of the results, and the conversion of a serum alcohol concentration to a blood alcohol concentration in units as per the Criminal Code. Pre-trial preparation, courtroom procedures, and suggestions to enhance the technologist's credibility as a professional witness are outlined.

Phlebotomy on trial

Collecting blood specimens can carry an element of risk for your laboratory-errors in judgment and technique may cause injuries that leave you vulnerable to litigation. In this article, an expert witness discusses six ways to protect your lab from phlebotomy liability.

Paving the road to maximum productivity

"Job security" is an oxymoron in today's environment of downsizing, mergers, and acquisitions. Workers find themselves living by new rules in the workplace that they may not understand. How do we cope? It is the leader's charge to take advantage of this chaos and create conditions under which his or her people can understand the need for change and come together with a shared purpose to effect that change. The clinical laboratory at Arkansas Children's Hospital has taken advantage of this chaos to down-size and to redesign how the work gets done to pave the road to maximum productivity. After initial hourly cutbacks, the workers accepted the cold, hard fact that they would never get their old world back. They set goals to proactively shape their new world through reorganizing, flexing staff with workload, creating a rapid response laboratory, exploiting information technology, and outsourcing. Today the laboratory is a lean, productive machine that accepts change as a way of life. We have learned to adapt, trust, and support each other as we have journeyed together over the rough roads. We are looking forward to paving a new fork in the road to the future.

Medicare, Medicaid, and CLIA programs; extension of certain effective dates for clinical laboratory requirements under CLIA--CDC, HCFA. Final rule with comment period

This final rule extends certain effective dates for clinical laboratory requirements in regulations published on February 28, 1992, and subsequently revised December 6, 1994, and May 12, 1997, that implemented provisions of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). This rule extends the phase-in date of the quality control requirements applicable to moderate and high complexity tests and extends the date by which an individual with a doctoral degree must possess board certification to qualify as a director of a laboratory that performs high complexity testing. These effective dates are extended to allow the Department additional time to issue revised quality control requirements and to determine whether changes are needed in the qualification requirements for individuals with doctoral degrees to serve as directors of laboratories performing high complexity testing. These effective date extensions do not reduce the current requirements for quality test performance.

Variation in proficiency testing performance by testing site

CONTEXT

Congress enacted the Clinical Laboratory Improvement Amendments of 1988 (CLIA) to promote uniform quality and standards among all testing sites in the United States. The performance indicators specified in the legislation are proficiency testing (PT) performance and periodic inspections.

OBJECTIVE

To evaluate variation in PT performance by type of testing facility during the first year of compulsory participation under CLIA.

DESIGN

All 1994 PT score data electronically reported to the Health Care Financing Administration as a component of compliance with the CLIA regulations were obtained. Over 1.2 million PT event scores from 17058 unique testing sites were sorted into 2 groups based on the type of testing facility: hospitals and independent laboratories (HI) and all other testing sites (AOT).

MAIN OUTCOME MEASURES

Satisfactory and unsatisfactory performance rates for HI and AOT for each analyte and/or test, according to the criteria specified by the CLIA regulations.

RESULTS

The aggregate rates of satisfactory event performance for all regulated analytes, tests, and specialties were 97% and 91% for the HI and AOTgroups, respectively. The aggregate odds ratio for unsatisfactory PT event performance for the AOT group compared with the HI group was 2.89, with a range of 2.19 to 7.51 for the individual analytes.

CONCLUSION

There was a consistent difference in PT performance during the first full year of compulsory PT under the CLIA regulations based on the type of testing facility performing the analysis. Traditional testing sites achieved higher rates of satisfactory performance than newly regulated, alternative testing sites.