Point-ot-care decision making, adaptive systems, and outcomes optimization (and the national directives tor improved healthcare)

The goal of this chapter is to describe clinical approaches to optimizing pointof-care testing (POCT) for rapid decision making and improved medical and economic outcomes. The objectives of the chapter are • To understand the national directives established by the Institute of Medicine (10M) and the World Health Organization (WHO) for improving patient care • To highlight the advantages and disadvantages of POCT, and to describe two essential performance attributes, therapeutic turnaround time (ITAT) and test clusters • To illustrate the logic of adaptive POCT systems, including integrative strategies, performance maps, algorithms, and care paths, that blend rapid response testing effectively in critical care • To arrive, based in part on the tenants of evidence-based medicine (EBM), at optimizing principles that will endure future advances in POCT and the demands of twenty-first century medicine Chapter 4 discussed the recommendations in the first 10M monograph, To Err Is Human: Building a Safer Health System (1), for reducing medical errors and unnecessary deaths in the United States. Consistent with national concerns about safety, that chapter presented systems for preventing medical errors in POCT (2). This chapter takes a broader perspective, based primarily on directives for improving healthcare delivery in the recent 10M publication, Crossing the Quality Chasm: A New Health System for the 21st Century (3), and shows how to use adaptive POCT systems to improve patient outcomes.