CLINICAL LAB SCIENEC

CHAPTER 7: MEDICAL ECONOMICS AND LABORATORY EQUIPMENT 169
of services, when the old equipment has been occasionally checked out and otherwise
maintained. A disruption of laboratory services will impact the physician
and the ability to diagnose a condition, which may be dangerous to the patient’s
health.
Most larger laboratories have maintenance contracts that provide for on-site
repairs and maintenance. Routine preventive maintenance is often a function of
laboratory technical personnel and serves to prevent some of the time-consuming
and costly malfunctions. Accurate records of daily documentation of repairs and
preventive maintenance are required to aid in determining why an instrument
might have malfunctioned. Sometimes signs appear in the instrument’s operation
that may signal an imminent problem with its operation. One of the most
important responsibilities of a technologist in a laboratory is to take care of the
equipment and to perform all required maintenance procedures to avoid a great
deal of inconvenience and perhaps harm to the patients served.
Point-of-Care Testing: A Step Toward the Future?
Because the health care industry is changing rapidly, it is imperative that laboratorians,
from management to bench workers, keep their options open as to what
is most expedient, cost-effective, and beneficial for the patients. Why is pointof-care
testing (POCT) included in this chapter? The reason is that the costs per
test are higher than the batch tests performed in the laboratory, but personnel
costs are low, as those already working in the patient care areas are the ones
who perform these tests; thus the tests are at least somewhat cost effective. It is
not sufficient to maintain the status quo and those who do not embrace change
should not consider laboratory technology as a profession. Changes in methodology
for laboratory procedures are emerging rapidly and show no sign of abating.
All aspects of the field, including technology, automation, laboratory information
systems, robotics, and principles of economics, are evolving daily.
POCT is moving ahead as a major avenue of change. Originally, POCT did
not address economic practices, but with the advent of smaller and more portable
instruments, more and more procedures may be performed at the bedside
of the patient, or in the patient’s home. More POCT is not a solution to providing
better care to more people, but it may be a possible answer to some of the
problems of delivering timely results in laboratory medicine.
Since the advent of modern laboratory testing, particularly in the 20th century,
procedures have been performed in a central laboratory by well-trained
laboratory workers. Other ways of bringing testing closer to the patient lie in
the formation of specialty laboratories situated near the patient treatment area.
Even a few decades ago, it was common for some specific testing to be performed
in “satellite” laboratories that were at separate locations from the main laboratory.
But this differed from POCT, in that procedures were still performed by
clinical laboratory technicians and technologists. In contrast, POCT is normally
performed close to or at the patient’s location and in most instances by nurses
and other nonlaboratory personnel. This phenomenon may lead to an increase
of testing by nontechnical personnel, as easy to operate and transportable equipment
becomes more available. Change is most likely inevitable, and many technicians
and technologists, along with some professional societies, oppose the
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