One meter, one confusing result

A nurse scans a glucose meter at the bedside of an adult on peritoneal dialysis, day three of an icodextrin-containing exchange solution. The badge scan accepts a trained, in-date operator. The wristband barcode matches the admission record. The meter reads 182 mg/dL and flags the result in range. It transmits to the laboratory information system (LIS) in under a minute, well inside the unit's connectivity target. Every step that a connectivity system checks has passed.

The nurse charts one more thing: the patient is diaphoretic and mildly confused, a picture that does not fit a glucose of 182 mg/dL. Nothing about the meter, the operator, or the transmission looks wrong. This is not just about one meter reading. It is about how a laboratory keeps one quality system running when testing happens on hundreds of devices, in dozens of locations, operated by staff who are not laboratorians and who see a device like this only a few times a shift.

Point-of-care testing (POCT) is testing performed at or near the patient, outside the physical space of the central laboratory, using hand-carried kits or instruments, or devices brought temporarily to a care area. It does not include a fixed-space limited-service satellite laboratory or patient self-testing done outside a clinical program. The laboratory is accountable for POCT results the same way it is accountable for a result run on a core analyzer, even though the person at the keyboard, or the badge scanner, reports to nursing, not to the laboratory.

Decentralized testing does not mean decentralized accountability. One CLIA (Clinical Laboratory Improvement Amendments) certificate, one quality system, has to reach every device, every site, and every operator.