How To Improve Poc

Transcription

1 Synthèse et conclusions Michel Vaubourdolle Pôle de Biologie Médicale et Pathologie Hôpitaux Universitaires de l Est parisien AP-HP 5 ème Symposium International «Biologie d urgence et gaz du sang» Deauville 31 Mai 1 er Juin 2012

2 GOALS IN POCT (1) POCT Overview in 2012: benefits, issues and expectations - Paul HOLLOWAY Combination Rapid developments in diagnostics technology Increasing cost pressures Lead traditional testing processes To increase efficiency To reduce therapeutic turnaround time for an increasing number of analytes

3 GOALS IN POCT (2) POCT Overview in 2012: benefits, issues and expectations - Paul HOLLOWAY Bringing diagnostic testing closer to the patient and thus reducing therapeutic turnaround time Benefits more rapid clinical decision making, triaging, monitoring, identifying dangerous pathogens reducing the financial and clinical costs of patient care

4 GOALS IN POCT (3) POCT Overview in 2012: benefits, issues and expectations - Paul HOLLOWAY Extension of POCT to pathogen recognition and treatment sensitivity also to improve medical care at scenes of disaster and terrorist injuries

5 GOALS IN POCT (4) POCT Overview in 2012: benefits, issues and expectations - Paul HOLLOWAY Establish processes to incorporate the stringent existing laboratory standards into POCT management Focusing efforts on quality and risk management where POCT is managed from a laboratory base Pressure on IVD companies for the associated connectivity and on laboratory budgets to manage quality of POCT

6 From patient care to quality management Evolution of clinical needs in critical care testing and POCT Innovation and new technologies Quality management in POCT

7 Evolution of clinical needs in critical care testing and POCT (1) Reduction in therapeutic TAT of validated tests POCT in neonatalogy Bruno CARBONNE, Agnès MAILLOUX Limit caesarian operations using fetal scalp ph Prevent and treat neonatal icterus using POCT bilirubin

8 Evolution of clinical needs in critical care testing and POCT (2) Reduction in therapeutic TAT of validated tests Hémostase délocalisée en salle d opération : quels avantages pour le clinicien? Pierre TOULON Anticoagulation control by unfractionated heparin during ECC in cardiac surgery: ACT Interventional cardiology: APTT Assessment of global patient coagulation state and blood transfusion optimization: PT, INR Global exploration of hemostatic system: TEG Cost/benefit in local conditions Standardization and guidelines needed

9 Evolution of clinical needs in critical care testing and POCT (3) Reduction in therapeutic TAT of validated tests La mesure délocalisée de l INR pour la surveillance des traitements par antivitamine K : pourquoi, comment et pour qui? Dr Dominique LASNE Hemorrhagic syndrome or VAK overdose : INR with TAT<15 min. Issues to obtain a direct venous sample collection : pediatrics, geriatrics Care structures far from a clinical lab

10 Evolution of clinical needs in critical care testing and POCT (4) Extending classic POCT for ICU patient care beyond blood gases ICU: beyond blood gases - Jean-Louis DABAN Continuous measurements Differentiation of inflammation and infection PCT, inflammatory scores Death risk stratification PTX3, genetic arrays Organ failure Neurology : S100 protein, Cardiology : HFABP Nephrology : NGAL Needs more clinical validation

11 Evolution of clinical needs in critical care testing and POCT (5) Enhanced care unit organization POC in ED: is there a benefit for patient care? Which impact on ward internal organization - Petra WILK Decrease in ED overcrowding Decrease in ED LOS Using POCT blood gases, NT-pro BNP and Troponin I Personal comment: under lab responsibility in France

12 Evolution of clinical needs in critical care testing and POCT (6) Enhanced care unit organization HbA1c en consultation de diabétologie : intérêt pour la prise en charge du patient? - Pr Philippe GILLERY, Céline LUKAS-CROISIER Patient follow-up in pediatrics with repeated venous blood sampling Aged patients without degenerative complications Issues in reliability of capillary glycemia Absence of home glycemic management No recent laboratory HbA1c

13 Innovation and new technologies (1) Changes in the practice of critical care medicine Electrochemical Sensors in Medicine: Meeting Needs for the 21st Century - Mark MEYERHOFF Miniaturized potentiometric and amperometric sensors for ions (K+,Ca++, Na+, Mg++, Cl-, H+), gases (O2 and CO2), and nutrients/metabolites (glucose, lactate, creatinine, urea) past 30 years Measurements of polyionic drugs and associated contaminants, carriers of NO Solution to biocompatibility problem associated with use of intravascular sensors for real-time monitoring of critically ill patients

14 Innovation and new technologies (2) Improvement of infectious diseases diagnostic using molecular POC tools POC molecular testing: feasible and useful in microbiology? - Pierre-Yves LEVY Development of central microbiology labs is associated with increase in TAT for infectious diseases diagnostic POCT or proximity testing allows TAT <4h Questions : needs for patient hospitalization, isolation, initiation of targeted therapeutics? Cost/benefits study needed for these new devices

15 Innovation and new technologies (3) Enhanced connectivity to improve patient care and develop remote quality management system Les glycémies capillaires au chevet du patient surveillées et contrôlées dans les unités de soins : rôle du laboratoire central et apport de l informatique : expérience du CHU de Bordeaux - P. DERACHE Lab-based POC glucometers management with remote control of QC, e-learning, users, wireless connexion Possible management of a large number of devices (n=700)

16 Innovation and new technologies (4) Enhanced analysis and connectivity to improve blood gases management in surgery and ICU Blood gas measurements and Remote data management for surgery and intensive care unit - the innovative experience - Gitte OLANDER Optimized pre-analytical steps Analytical quality as good as in the laboratory Remote data management

17 Innovation and new technologies (5) Reduced clinical risk and improved patient safety during pre-examination phase Introducing RFid in blood gas process helps reducing pre analytical errors: an example of integration of ISO, health assessment and risk management - Stefano PASTORI Risk assessment study of processes integration of RFID technology to unambiguously identify the patient and the operator

18 Innovation and new technologies (6) Reduced clinical risk and improved patient safety during examination phase Innovations techniques et habilitation du personnel en biologie délocalisée M. Boisson Training habilitation of POCT users is a critical step for remote quality management system Use of built-in dedicated software in POC device is needed to manage a large number of operators

19 Quality management in POCT (1) ISO accreditation : 2 labs in France In Paris : Pascal PERNET, Bénédicte BURNAT In Marseille : Véronique CHAPOY, Henri PORTUGAL French regulation Mandatory accreditation for all POC tests, under responsibility of specialists in laboratory medicine European approach ISO standard as an international common reference

20 Quality management in POCT (2) Roundtable: a mandatory ISO accreditation in France: a new challenge for specialists in laboratory medicine Dr Anne Marie GALLOT, DGS Dr Michel BALLEREAU, Rédacteur du rapport sur la Biologie Médicale Dr Véronique GARDET, CTA COFRAC Dr Robert DESMOULINS, Ordre des Pharmaciens Dr Jean CANARELLI, Ordre des Médecins

21 Quality management in POCT (3) Mandatory accreditation of POCT tests in the next 6 years is a big challenge POCT quality management is heard as An heavy new constraint A restructuration tool But it is also A real progress in patient care and patient safety A very efficient lab management tool A federative project for clinical and laboratory teams

22 Conclusions We hope you followed our exciting trip from patient care to quality management Evolution of clinical needs in critical care testing and POCT Innovation and new technologies Quality management in POCT Good trip in your lab/care unit! And stay all with us this afternoon to see with our US colleagues the Quality management and point-of-care testing: the US approach

23 Thank you for your attention See you in 2015 for the 6th International Symposium «Critical care testing and blood gases»