Rapid testing is the way of the future, and it begins with point-of-care testing (POCT). POCT moves testing from the laboratory setting to the patient’s bedside, which has had a positive impact on therapeutic turnaround time. Rapid testing gives accurate results in hours, not days, and in some cases, results are available in minutes.1 Currently, POCT is available for whole blood profile, cardiac markers, drug screens, basic metabolic panel, HIV, hepatitis C virus (HCV), syphilis, stroke, cancer, strep infection, and influenza.2
As the director of patient care in the emergency department (ED), emergency physicians play an important role in the POCT process. This includes implementing policies and procedures that will improve patient care and control costs. POCT requires that new policies and procedure be evaluated and implemented and will have an effect on cost.
With POCT, test results are returned rapidly and testing costs are greatly diminished. Rapid tests, such as those for HIV and HCV, cost between $10 and $30 per test kit, while laboratory testing may cost several hundreds of dollars and take several days. Additionally, the cost of POCT testing can be a fee generated for the ED, and in the current world of contracted laboratory services, become a revenue generator.
Studies have shown that rapid testing has decreased the number of antiretroviral postexposure prophylaxis regimens that were started while waiting for source patient test results. This clearly is a cost benefit for the health care provider.
Origin of Rapid Testing
The Centers for Disease Control and Prevention (CDC) guidelines for postexposure prophylaxis for hepatitis B virus (HBV), HCV, and HIV are well recognized as a standard of medical care, and are enforced by the U.S. Department of Labor’s Occupational Safety & Health Administration (OSHA), as noted in OSHA’s Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens.3,4
In June 2001, the CDC updated its guidelines for postexposure source patient testing, to recommend that “testing to determine the HBV, HCV, and HIV infection status of an exposure source should be performed as soon as possible. Hospitals, clinics, and other sites that manage exposed [health care personnel] HCP should consult their laboratories regarding the most appropriate test to use to expedite obtaining these results. An FDA-approved rapid HIV-antibody test kit should be considered for use in this situation, particularly if testing by [enzyme immunoassay] EIA cannot be completed within 24–48 hours.”3
This was the beginning of rapid testing related to postexposure medical follow-up. Rapid testing for HIV has been available since 1998, and in 2010 the FDA approved rapid testing for HCV. It is important to note that rapid HIV and rapid HCV testing has been waived from Clinical Laboratory Improvement Amendments (CLIA) compliance and can be done in the ED.5,6 In fact, rapid HIV testing was piloted in EDs. Because the current rapid HIV tests screen for proteins present in the beginning the life cycle of the virus, the CDC has published that there is no window phase with rapid HIV testing.7