[Trends in indication of selected laboratory methods by general practitioners]

The indication of laboratory methods in general practice is significantly influenced by practical guidelines and protocols for preventive care. The financial regulation pushes on rationalisation of the use of laboratory methods. Point of care testing is more and more important in prevention, diagnostics and follow up in primary care settings.Based on the data available from Škoda Insurance Company authors aimed to describe trends in induction and cost of laboratory methods, the most frequent methods used in primary care and trends in the use of POCT methods within general practice.The expenditures for laboratory methods in general practice are stable for a long term and suggest a rational behaviour of general practitioners. The most frequently indicated methods in general practice are glycaemia, ALT and AST. From expensive methods the most frequent are PSA, troponin and tumormarkers. The number of general practices performing POCT methods and also the number of POCT examinations increase. More than one half of INR examinations and nearly half of all CRP examinations are performed in POCT regime.

KEY WORDS

laboratory methods, clinical biochemistry, general practitioner, primary care, POCT.

MALDI-TOF Mass Spectrometry: A Powerful Tool for Clinical Microbiology at Hôpital Principal de Dakar, Senegal (West Africa)

Our team in Europe has developed the routine clinical laboratory identification of microorganisms by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). To evaluate the utility of MALDI-TOF MS in tropical Africa in collaboration with local teams, we installed an apparatus in the Hôpital Principal de Dakar (Senegal), performed routine identification of isolates, and confirmed or completed their identification in France. In the case of discordance or a lack of identification, molecular biology was performed. Overall, 153/191 (80.1%) and 174/191 (91.1%) isolates yielded an accurate and concordant identification for the species and genus, respectively, with the 2 different MALDI-TOF MSs in Dakar and Marseille. The 10 most common bacteria, representing 94.2% of all bacteria routinely identified in the laboratory in Dakar (Escherichia coli, Klebsiella pneumoniae, Streptococcus agalactiae, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus haemolyticus, Enterobacter cloacae, Enterococcus faecalis, and Staphylococcus epidermidis) were accurately identified with the MALDI-TOF MS in Dakar. The most frequent misidentification in Dakar was at the species level for Achromobacter xylosoxidans, which was inaccurately identified as Achromobacter denitrificans, and the bacteria absent from the database, such as Exiguobacterium aurientacum or Kytococcus schroeteri, could not be identified. A few difficulties were observed with MALDI-TOF MS for Bacillus sp. or oral streptococci. 16S rRNA sequencing identified a novel bacterium, “Necropsobacter massiliensis.” The robust identification of microorganisms by MALDI-TOF MS in Dakar and Marseille demonstrates that MALDI-TOF MS can be used as a first-line tool in clinical microbiology laboratories in tropical countries.

Auto-validation of complete blood counts in an outpatient's regional laboratory

BACKGROUND

The rate of auto-validation is dependent on the ability of the laboratory information system (LIS) to integrate historical data, on the frequency and methods for identifying analyzer errors, and on the criteria for reflex testing, including the need for peripheral smear review. The rate of auto-validation in outpatient laboratories, however, is unclear.

METHODS

We examined 45,925 consecutive complete blood count (CBC) test results (1 January, 2014-31 January, 2014) from patients aged 50±24 years. The LIS auto-validates all samples according to set criteria. Technicians validated test results when previous CBC test results were required to determine: 1) the need for peripheral slide review and/or sample rerun or 2) the need for reflex testing to detect autoimmune hemolytic anemia or β-thalassemia minor.

RESULTS

The auto-validation rates were 97.6% after rejecting results requiring validation to determine the need for a peripheral smear review and/or sample rerun. This decreased to 92.9% after including reflex testing to determine the reasons for normocytic and microcytic anemia. We estimated that auto-validation decreased the workload by 7.7-11.6 h per 3000 test results.

CONCLUSIONS

We conclude that very high auto-validation rates are possible in outpatient general laboratories, leading to conformity in the validation process and a considerable estimated savings in technician time. Further studies are needed in other settings.

[Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012]

INTRODUCTION

Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported.

METHODS

A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients.

RESULTS

The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007- 2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional.

CONCLUSIONS

The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nursing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated.

[Results of Training for Personnel Involved in Blood-Transfusion Testing Outside of Regular Work Hours at Saga University Hospital]

Laboratory testing prior to blood transfusion outside of regular hours in many hospitals and clinics is frequently conducted by technicians without sufficient experience in such testing work. To obtain consistent test results regardless of the degree of laboratory experience with blood transfusion testing, the number of facilities introducing automated equipment for testing prior to blood transfusion is increasing. Our hospital's blood transfusion department introduced fully automated test equipment in October of 2010 for use when blood transfusions are conducted outside of regular hours. However, excessive dependence on automated testing can lead to an inability to do manual blood typing or cross-match testing when necessitated by breakdowns in the automated test equipment, in the case of abnormal specimen reactions, or other such case. In addition, even outside of normal working hours there are more than a few instances in which transfusion must take place based on urgent communications from clinical staff, with the need for prompt and flexible timing of blood transfusion test and delivery of blood products. To address this situation, in 2010 we began training after-hours laboratory personnel in blood transfusion testing to provide practice using test tubes manually and to achieve greater understanding of blood transfusion test work (especially in cases of critical blood loss). Results of the training and difficulties in its implementation for such after-hours laboratory personnel at our hospital are presented and discussed in this paper. [Original]

[Measures to Ensure Ongoing Medical Laboratory Support of the Emergency Department]

Following the accreditation of this hospital as an Emergency and Critical Care Center and the subsequent establishment of an emergency intensive care unit in April 2013, walk-in patients of the Emergency Department now total over 60,000 annually, with 10,000 arriving by ambulance. Out-of-hours medical laboratory services in this hospital commenced in 1972, providing services including blood analysis and blood product provision. Since the establishment of the Emergency and Critical Care Center, an increase in the number of severe cases has also led to an increase in blood transfusions, requiring a specialized response from the Medical Laboratory. We describe measures taken by the Medical Laboratory to continue ongoing laboratory support of the Emergency Department. [Review].

Differential Diagnosis: Shape and Function, Fractal Tools in the Pathology Lab

Fractal analysis is a useful objective tool in describing complexity of shapes and signals providing information for understanding pathological changes. We present fractal approaches and software used in our pathology laboratory to analyze shapes of tumors in tissues and cells, to evaluate the microvessel network complexity in hereditary diseases or the complexity of the surface of blood cells in atherosclerosis-linked condition, as well to analyze function in vasculopathic subjects by chaotic analysis of electrocardiographic signals, in order to perform differential diagnosis. The fractal parameters appear to converge towards distinct values in pathological conditions compared to healthy, approaching the characteristics values of a percolation process or the diffusion-limited aggregation process, respectively: a bifurcation that allows to support the diagnostic process of the pathologist in his daily work. These methods, presented here as a kind of a cookbook ready for the pathologist, are low cost and not time consuming.

[How to Interpret and Use Routine Laboratory Data--Our Methods to Interpret Routine Laboratory Data--Chairmen's Introductory Remarks]

In the reversed clinicopathological conference (R-CPC), three specialists in laboratory medicine interpreted routine laboratory data independently in order to understand the detailed state of a patient. R-CPC is an educational method to use laboratory data appropriately, and it is also important to select differential diagnoses in a process of clinical reasoning in addition to the present illness and physical examination. Routine laboratory tests can be performed repeatedly at a relatively low cost, and their time-series analysis can be performed. Interpretation of routine laboratory data is almost the same as taking physical findings. General findings are initially checked and then the state of each organ is examined. Although routine laboratory tests cost little, we can gain much more information from them about the patient than physical examinations.

Using Hospital Laboratory Services to Perform Quality-control Testing on Compounded Preparations

There are many important factors in ensuring the successful preparation of both sterile and nonsterile compounded preparations. One of these factors is ensuring that the potency of the preparation is correct. Using a hospital laboratory can be a viable option when looking at ways to expand your quality-control program, as long as the methods are validated. It can help reduce the cost of purchasing and maintaining your own equipment by utilizing existing resources and avoiding duplication of the quality-control testing of the equipment. You can also tap into the expertise available in the laboratory. Using a hospital laboratory can help you to achieve your goal of meeting current compounding standards and providing an accurate preparation.

The interventional cardiologist as cath lab team leader

Interventional cardiologists act as leaders every time they step into a catheterization laboratory (cath lab), but leadership training is rarely included in cardiology training programs. Cath lab physicians should cultivate and practice effective leadership skills. Specifically, (1) before each procedure assess whether the cath lab team is prepared; (2) delegate authority to trainees and team members when appropriate; (3) use every procedure to improve the performance of team members through teaching, coaching, and mentorship; (4) debrief the team after adverse events; (5) develop the traits, styles, and skills associated with successful leadership; and (6) provide team training for the cath lab team.

[The role of clinical laboratory diagnostics in dental caries prognosis in children]

The aim of the study was to identify informative, in terms of predicting caries process, laboratory parameters of homeostasis of the oral cavity in children of different age groups. A total of 1158 children of preschool and school age with caries were screened to determine laboratory parameters of homeostasis of the oral cavity by examining of the oral fluid. Caries in children was characterized by certain age specific physico-chemical parameters shift in the oral fluid. Complex set of the most informative laboratory indices reflecting the resistance and susceptibility to dental caries in children of different age groups was revealed. The obtained data allowed creating mathematical models for prenosological prediction of caries in preschool and school age, which formed the basis of "Stop caries" software.

[Team approaches to critical bleeding (massive bleeding and transfusion) - chairmen's introductory remarks. Questionnaire survey on current status of hospital clinical laboratories evaluating critical hemorrhage]

In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).

[Contribution of central hospital laboratory to critical bleeding]

It has been reported that fibrinogen products, such as fibrinogen concentrates, cryoprecipitate (CRYO), and fresh frozen plasma, are beneficial for treating coagulopathy due to massive blood transfusion. For the appropriate use of these products, it is necessary to evaluate the status of coagulopathy and determine the trigger level of the fibrinogen concentration for the administration of fibrinogen products. In our institution, we established a treatment procedure for coagulopathy due to massive transfusion in 2011. This procedure includes determination of the trigger level for administration of CRYO (150 mg/dL), timing of sample collection for the evaluation of coagulation parameters (prothrombin time, activated partial thromboplastin time, and fibrinogen) and concentration status during the operation, and a method for rapid coagulation testing (turnaround time within 15 minutes) in critical bleeding. Since 2011, we have performed 56 rapid coagulation tests for patients suffering from critical bleeding. The average turnover time was 13 minutes. According to the rapid coagulation test results, CRYO was administered to 27 patients. These results are satisfactory for treating critical bleeding patients. We stress the need for the establishment of a rapid coagulation test system in the central hospital laboratory. (Review).

[How do hospital clinical laboratories and laboratory testing companies cooperate and build reciprocal relations?]

As the 2nd Joint Symposium of the Japanese Society of Laboratory Medicine and the Japanese Association of Laboratory Pathologists, the symposium on clinical test out-sourcing and branch laboratories was held at the 60th General Meeting of the Japanese Society of Laboratory Medicine on November 2nd, 2013 in Kobe. For the symposium, we conducted a questionnaire survey on the usage of clinical test out-sourcing and the introduction of branch laboratories to clinical laboratories of Japanese university hospitals, both private and public, between July 25th and August 20th, 2013. Seventy-two hospitals responded to the questionnaire survey, consisting of 41 public medical school hospitals and 31 private ones. According to the survey, the selection of each clinical test for out-sourcing was mainly determined by the capacities of hospital clinical laboratories and their equipment, as well as the profitability of each test. The main concerns of clinical laboratory members of university hospitals involved the continuity of measurement principles, traceability, and standardization of reference values for each test. They strongly requested the interchangeability and computerization of test data between laboratory testing companies. A branch laboratory was introduced to six hospitals, all of which were private medical college hospitals, out of 72 university hospitals, and eight of the other hospitals were open to its introduction. The merits and demerits of introducing a branch laboratory were also discussed. (Review).

[Security Management in Clinical Laboratory Departments and Facilities: Current Status and Issues]

We conducted a questionnaire survey regarding the current activities for protecting patients' privacy and the security of information systems (IS) related to the clinical laboratory departments of university hospitals, certified training facilities for clinical laboratories, and general hospitals in Yamaguchi Prefecture. The response rate was 47% from 215 medical institutions, including three commercial clinical laboratory centers. The results showed that there were some differences in management activities among facilities with respect to continuing education, the documentation or regulation of operational management for paper records, electronic information, remaining samples, genetic testing, and laboratory information for secondary use. They were suggested to be caused by differences in functions between university and general hospitals, differences in the scale of hospitals, or whether or not hospitals have received accreditation or ISO 15189. Regarding the IS, although the majority of facilities had sufficiently employed the access control to IS, there was some room for improvement in the management of special cases such as VIPs and patients with HIV infection. Furthermore, there were issues regarding the login method for computers shared by multiple staff, the showing of the names of personnel in charge of reports, and the risks associated with direct connections to systems and the Internet and the use of portable media such as USB memory sticks. These results indicated that further efforts are necessary for each facility to continue self-assessment and make improvements.

The utility of liquid-based cytology in salivary gland fine-needle aspirates: experience of an academic institution

OBJECTIVE

To review the morphological features of salivary gland fine-needle aspirates (FNA) on ThinPrep® (TP) preparations. Emphasis is placed on the commonalities and specific differences between TP and conventional smear (CS) preparations.

STUDY DESIGN

The cytology and surgical pathology archives were searched for 'salivary' or 'parotid' at our institution from 2003 to 2013 for cases processed by TP and with a range of specified diagnoses and surgical follow-up. These cases were reviewed by the authors. A review of the known literature was also performed.

RESULTS

Morphological features and artifacts were noted for the most common salivary gland lesions. General features noted in the literature were identified, along with novel features identified on our review of cases. Emphasis was placed on cellular alterations, extracellular differences and architectural changes.

CONCLUSIONS

The multitude of both benign and malignant lesions coupled with the unique artifacts encountered on TP makes salivary gland FNAs difficult for most practicing pathologists and cytopathologists. For this reason, many laboratories have been reluctant to implement TP preparations for these lesions. With knowledge of the specific artifacts and differences on TP compared to CS, TP can be used with confidence without a compromise in diagnostic accuracy for adequately cellular samples.

Applying lean flows in pathology laboratory remodelling

PURPOSE

This purpose of this paper is to examine the application and outcomes of applying all of the seven lean flows to pathology laboratory remodelling as part of a lean rapid improvement event (RIE).

DESIGN/METHODOLOGY/APPROACH

Longitudinal case study of a lean RIE linking emergency and pathology departments focusing on the systematic application of lean's seven flows to the physical environment.

FINDINGS

Following the lean RIE, changes improving patient specimen, technician, supplies and information flows avoided 187 km and eight days of unnecessary walking each year.

RESEARCH LIMITATIONS/IMPLICATIONS

The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged.

PRACTICAL IMPLICATIONS

This research provides evidence that applying lean design concepts in a laboratory can make substantial improvements, particularly if the expertise of the people working in the laboratory is trusted to determine the most appropriate changes. Significant amounts of time and motion were saved by just one, easily quantifiable change.

SOCIAL IMPLICATIONS

The laboratory staff is processing increased numbers of time-critical tests, yet report a calmer working environment, without any increase in the pace of work. Laboratory personnel also experienced satisfaction in exercising control over their work environment.

ORIGINALITY/VALUE

To the best of the authors' knowledge this is the first comprehensive report applying lean flows to pathology laboratory remodelling and one of the few applications of Lean Systems Thinking between departments and between separate health services organisations.

[Comments on routine laboratory data that are of practical use for physicians]

In the reversed clinicopathological conference (R-CPC), we analyzed a patient's pathosis using only the results of routine laboratory tests. R-CPC is one of the most effective training methods to acquire the abil- ity to interpret such data logically and reasonably. At the same time, we can know the limits of laboratory data, even though they can be analyzed in detail. In this R-CPC, three specialists in laboratory medicine discussed routine laboratory data of a patient with a ruptured abdominal aortic aneurysm. Then, they and moderators fielded a question-and-answer session with an audience in a hall. It was difficult for us to decide on the correct diagnosis, but we were able to analyze the data logically and reasonably in order to understand the patient's actual condition. It has been revealed that the Department of Laboratory Medicine can support physicians by adding comments to laboratory data that are of practical use to follow a patient.

Laboratory facility design and microbial indoor air quality in selected hospital laboratories

Hospital laboratory is one of workplace areas contaminated with a variety of biohazards. A cross sectional study was conducted to assess the microbial air quality and facility design in the laboratories of four selected governmental hospitals (Hospitals A, B, C, and D) in Bangkok, Thailand. One hundred eighty-eight indoor air samples were collected from 40 laboratory rooms to investigate bacterial and fungal counts using the Millipore air tester. Forty air samples were collected from the waiting areas of those laboratories, and 16 outdoor air samples were collected to use for comparison. Additionally, those laboratory facilities were assessed following biosafety facility design (10 items). Results indicated that the facility design of laboratory in the Hospital A met most of items of the biosafety facility criteria. The rest met only seven items of the criteria. Means +/- standard deviation (SD) of bacterial counts of 253.1 +/- 247.7 cfu/m3, 236.8 +/- 200.1 cfu/m3, 304.4 +/- 264.2 cfu/m3, and 146.7 +/- 127.0 cfu/m3, and fungal counts of 500.8 +/- 64.2 cfu/ m3, 425.0 +/- 21.2 cfu/m3, 357.0 +/- 121.2 cfu/m3, and 355.7 +/- 86.8 cfu/m3 were found in hospital laboratories A, B, C and D, respectively. The isolated colonies of bacteria and fungi were identified as group or genus. It was found that the most common bacteria was Staphylococcus spp (84.1%, 76.0%, 72.1% and 80.5%, respectively), whereas, the most common fungi were Aspergillus spp and septate hyphae fungi (42.0%, 37.5%, 39.5%, and 45.7%; vs 38.6%, 56.2%, 52.1%, and 37.2%, respectively). These data may be valuable to develop interventions to improve the microbial indoor air quality among hospital laboratories and for preventing the laboratory-acquired infections.

[College education for medical technologists of the next generation]

Medical Technologists (MTs) of the next generation will be expected to: 1) perform clinical tests in clinical laboratories as so-called Clinical Laboratory Scientists(CLS), 2)research and develop highly advanced reagents, devices, or procedures for clinical laboratories, and 3) educate MTs and research in the college or university. CLS are required to develop and maintain highly advanced medical skills as follows: (1) explaining medical tests and those results to patients, (2) evaluating and explaining test results to medical doctors, (3) advising medical doctors of laboratory diagnoses, (4) analyzing the patients' pathophysiology based on samples with aberrant results, (5) evaluating newly developed reagents, devices, or procedures, and (6) promoting the total medical cure of patients with specialized skills. In the MT course at Shinshu University, to develop the skills necessary to become a CLS before graduation, students participate in a number of programs, i.e., freshman seminars, observing the clinical laboratory, and basic training for medical tests (first grade), special lectures from MTs working in the clinical laboratory (second and third grades), examination for clinical practice, 12-week clinical practice, and 15-week laboratory research (fourth grade). Several academic members working in a clinical laboratory and collaboration with the Department of Clinical Laboratory at Shinshu University Hospital are essential to realize the above-mentioned course.

[Sources and distribution decision on reference values of myocardial injury markers in China: results from 150 laboratories]

OBJECTIVE

To analyze the sources and distribution decision limits on reference values of myocardial injury markers based on the feedback results of 150 laboratories which participated the 2012 external quality assessment (EQA) programs in China.

METHODS

Decision limits on myocardial injury markers from EQA programs were analyzed. Data from maternal and child care service center, children's hospital and corporations were excluded. Abnormal values and errors were eliminated. Mean, median, maximum value, minimum value, P2.5 and P97.5 were calculated. Sources of decision limits were summarized and data were filtered and only values obtained according to the reagent manufacturer's instructions as a reference source were used and grouped based on reagent characteristics.

RESULTS

According to the surveys on reference interval sources, most of reference sources were derived from reagent manufacturer's instructions and the ratio of each item was: CK-MB (µg/L) 91.30%, Mb (µg/L) 88.44%, cTn-I (µg/L) 86.29%, cTn-T (µg/L) 92.00%, CK-MB (U/L) 70.65%. According to the surveys, the mean and median values of each test parameter were close to each other (CK-MB:3.74, 4.94 µg/L;Mb:76.09, 72.00 µg/L; CTn-I:0.06,0.09 µg/L;cTn-T:0.01, 0.02 µg/L;CK-MB:23.00, 25.00 U/L) . There were significant variations on P2.5 and P97.5 distribution ranges: CK-MB 2.48-7.09 µg/L, Mb 46.00-140.03 µg/L, cTn-I 0.01-1.68 µg/L, cTn-T 0.01-12.61 µg/L, CK-MB 6.00-30.60 U/L. According to the surveys on using various reagents, there were also significant variations on P2.5 and P97.5 reagent distributions.

CONCLUSIONS

The decision limit of the mean and median for each test item is close to each other while the P2.5 and P97.5 distribution of each test item consistency is poor. There is therefore an urgent need to establish an uniform reference values for cardiac markers in China.

Adoption of array technologies into the clinical laboratory

Array-based methods are making substantial contributions to the discovery of disease biomarkers and are fueling the growth of multianalyte testing for disease diagnosis and treatment. The distillation of high-density array results into sets of signature markers promises to improve disease staging, risk stratification and treatment decisions. To accommodate the growing requirement for multiplex testing, clinical laboratories are converting several single-analyte tests into array-based formats. However, adoption of array technologies provides several challenges to the laboratory, which must evaluate these new formats, train laboratory personnel, market the new services and obtain reimbursement for new analytes. Liquid-bead arrays are an attractive format for routine clinical diagnostics due to a combination of appropriate analyte density, simultaneous array decoding and detection, and flexibility for rapid customization. In this review, the suitability of several array platforms to diagnostic testing and applications of liquid-bead arrays for cystic fibrosis testing, multidisease carrier status assays and leukemia subtyping are discussed. As our understanding of the clinical utility of new or established biomarkers and recommendations for testing change, flexibility and adaptability of array platforms will be imperative. Future development of novel assay formats and improved quantitation will expand the number of diseases tested and lead to further integration into the diagnostic laboratory.

Quality in point-of-care testing

Point-of-care testing (POCT) is an increasingly popular means of providing laboratory testing at or near to the site of patient care. POCT provides rapid results and has the potential to improve patient outcome from earlier treatment. However, a faster result is not necessarily an equivalent result to traditional, core laboratory testing. Preanalytic, analytic and postanalytic factors can influence the quality of POCT and lead to misinterpretation. Concerns over the quality of POCT have resulted in a hierarchy of laboratory regulations in the USA and POCT guidelines are appearing in a number of countries worldwide. Quality POCT must control every aspect of the test and testing process that can affect the ultimate result. Laboratory quality regulations are very similar to industrial quality requirements and POCT can be viewed like any manufacturing business where the product being produced is the test result. Use of industrial management techniques, such as failure mode and effects analysis, can be applied to POCT to isolate and reduce the sources of testing error. Data management is fundamental to quality. Analyzing POCT data can show quality trends before they affect the result. Newer POCT devices have computerized data capture and storage functions that can collect the key information at the time the test is performed and later transmit that data to a POCT data manager or hospital information system. Recent standards, such as the National Committee for Clinical Laboratory Standards POCT1-A, provide a connectivity standard to allow different POCT devices to share a common interface and data manager system, reducing the cost of implementing and maintaining POCT. Guaranteeing POCT quality is resource-intensive and as healthcare budgets get tighter and staffing shortages grow, patient outcome must be weighed against available resources to determine optimum testing strategies. Use of the POCT literature can help establish an evidence-based justification to support POCT.