August 2010
Feature Story

Anne Ford

It’s often said that to get what you want, you have to identify what you want. And what Eileen Esposito, RN, DNP, wants is more pathologists who are willing to collaborate with colleagues on point-of-care testing.

“I want someone who can sit at a table with the end users and not say, ‘You can’t have that point-of-care test,’ but ‘Let’s talk about the test you’re requesting, and let’s talk about its pros and cons,’” says Esposito, assistant executive director of ambulatory patient care services and quality, North Shore-Long Island Jewish Health System, Manhasset, NY, and a consultant to the College’s POC Testing Committee.

So when Esposito sat down to write the section of the CAP’s new online Point-of-Care Testing Tool Kit that covers what RN ambulatory care administrators want from pathologist point-of-care testing directors, she took the opportunity to get specific about the qualities of an ideal POC testing director. As she wrote, that would be someone with “excellent communication skills” who “is open to new technologies and practice realities” and “can tactfully educate peers and practitioners.”

“I listed the attributes of what I would consider the ultimate POCT director,” she says. “I described the ideal.”

That’s not to say that the tool kit—which was online as of Aug. 2 at www.cap.org—is some pie-in-the-sky document. Several years in the making, it’s intended to give readers hard-and-fast information on point-of-care testing, from its history and indications to its implications for the roles of pathologists and other users. A much longer second edition, planned for release in January, will contain case studies as well as a technical section on method validation, proficiency testing, quality management and safety, device and reagent management, and more. Additional updates and expansions are expected to take place a few times yearly.

The tool kit’s initial goals are two- fold, says Cynthia Foss Bowman, medical director of clinical laboratories and director of POC testing at Long Island-Jewish Medical Center and chair of the College’s POC Testing Committee: to help orient pathologists who haven’t directed point-of-care testing before and to serve as a resource for pathologists who are already involved with this type of testing.

But there’s a third goal, Dr. Bowman adds. “What we’re really aiming for here is an interactive site where we’re building a community of users and directors of point-of-care testing,” she says. “We look at it as a really collaborative venture. We may say some things in the document that not everybody agrees with, or that some people may question. We’re looking forward to that, because we’re looking forward to developing a conversation about point-of-care testing, finding the different perspectives on it, the different ways people have found to practice it effectively or oversee it.”

That said, the tool kit “is not a wiki,” Esposito cautions. “But everyone who reads it should feel free to offer feedback on it. This is a document that’s going to morph over time even as point-of-care testing morphs over time.”

Dr. Bowman provides a brief walk-through of the tool kit’s first edition: “The first part is an introduction and definition of point-of-care testing that orients the user to the document and to the discipline. Then we go into the advantages and disadvantages. We have a sizable area where we talk about the history. We go through the drivers—why the market will grow and why it is growing—and we are developing a comparison of the different technologies for different tests. We go into pathologists’ roles in point-of-care testing. There’s a section on the pathologist as laboratory director and one on the pathologist as clinical consultant.

“There are all sorts of tools for assessing whether point-of-care testing is indicated, and if it is, then there are all the issues one needs to consider when beginning a program or introducing a test,” Dr. Bowman continues. “We give some tools for a business plan. And then we introduce the point-of-care coordinator.”

Since “there’s probably no place like point-of-care testing that is as collaborative in laboratory med­icine,” Dr. Bowman says, the makeup of the team that developed the tool kit reflects that em­pha­sis on collaboration. Among the kit’s cre­ators are Frederick A. Browne, MD, MBA, an infection control physician who serves as chief medical officer at New Milford (Conn.) Hospital, and Dawn M. Taylor, MA, MLS (ASCP)CM, a former point-of-care coor­dinator who’s now manager of laboratory education and program director of the School of Medical Technology, St. John Providence Health System, Grosse Pointe Woods, Mich. Vendors, CLSI and AACC representatives, and pathologists from several disciplines also provided input.

Though the tool kit is aimed at pathologists, its creators say other professionals can learn from it as well. To that end, the kit will be available to anyone, not just to CAP members. Dr. Browne would like in particular for pathologists to use the document as a teaching tool to educate and foster a greater understanding of what goes into the decision to use a given POC test. “Sometimes clinicians see point-of-care testing from the aspect of ‘Too many regulations, we can’t do this,’ and sometimes from the aspect of, ‘We’re just going to pick up this test and start using it,’” he says. On the flip side, he adds, “Sometimes the pathologist believes a clinician is not interested in point-of-care testing—they just want the test done. I think it’s important for pathologists to know that clinicians actually want to know how these tests work and what goes into getting them available to use in an institution.”

“I really think point-of-care coordinators will benefit from the tool kit as well,” Taylor chimes in, “because so much of what they do on a day-to-day basis is addressed. There are hands-on templates that can be used for the various aspects of running the program. It’s both a training document for new coordinators and a valuable reference for experienced individuals.”

Taylor’s major contribution to the tool kit—the section on competency assessment in the point-of-care setting—will appear in the second edition. That section, she says, will address some of the unique challenges of assessing the competency of health care professionals who perform laboratory tests outside the laboratory environment. “For example, you may be helping assess competency of nurses who are running a particular point-of-care test, and you don’t work with those nurses every day, so you have to learn about their processes and develop a competency assessment plan that fits,” she says.

The tool kit’s goals dovetail with the transformation of pathology as a profession, Dr. Bowman says. For one thing, point-of-care testing “plays into personalized medicine,” she says. “It’s a component of patient empowerment and of the decentralization of medicine.” For another, the tool kit encourages pathologists to provide more active, prominent leadership in the point-of-care realm. “The tool kit is actually aimed as a leadership document,” she says. “We want pathologists to be active participants in point-of-care testing.”