Where Lab Tests Are Performed

At Home

More and more tests are being adapted for use at home, as patients take on responsibility for their health care. Some of the more common home tests include pregnancy tests and ovulation predictors for women, blood glucose monitors for diabetics and prothrombin-time tests to monitor the doses of drugs that thin the blood.

Home tests are available directly over the counter at pharmacies, over the Internet, by telephone and by mail. Some may require a doctor’s prescription. Home tests offer definite advantages, including convenience, privacy and rapid results. However, there are a number of potential pitfalls, and consumers should think carefully before ordering home tests. For example, results can be inaccurate if the kit has not been stored properly, if the sample was not collected correctly or if the instructions were not followed. In addition, professional advice to understand the significance of a particular result may be required, and it is advisable to discuss home tests with your doctor or pharmacist before carrying them out.

Under European Union legislation (the In Vitro Devices Directive), all home diagnostic tests require a CE mark to be sold legally in the UK, and some tests for specific applications (e.g. self-test devices for blood glucose analysis) require special certification from the Medicines and Healthcare Regulatory Agency

At the Point of Care

Laboratory tests may also be performed at the actual point of care - in other words, where the patient is (at the bedside or in the GP surgery or clinic) rather than in a laboratory. Laboratory tests in these places are usually limited to uncomplicated tests. Tests done at the point of care can be more expensive compared to laboratory tests, but they are more convenient for patients and provide rapid results.

Point of care testing is increasing as technological advances bring about portable devices that are easy to use and produce immediate results. Examples include blood glucose tests, blood gas monitoring systems and analysers for tests for blood clotting and to detect heart attacks. Tests performed at the point of care must comply with standards just like those performed in central laboratories (see Laboratory Accreditation article), and proper systems of quality control must be in place. It is expected that point of care testing will continue to develop as new devices become available, in part because they may reduce delays and provide immediate information to doctors, allowing more timely medical treatment.

In a Hospital Laboratory

Almost all hospitals contain a laboratory, which is usually proportional in size to the population that it serves. Tests that are performed include those that are needed in emergency situations (such as markers for heart attacks and tests needed for checking the suitability of blood for transfusion) and those done in large numbers which require automated testing analysers.

Hospital laboratories are generally used by inpatients and outpatients for the particular hospital, and receive samples from GP surgeries in the immediate area, usually transported by a collection service organised by the local laboratory. However, as a patient you may never visit the laboratory unless your doctor asks you to go there to have a sample taken.

Hospital laboratories are usually organised into sections depending on the type of testing to be performed. For example, there are usually sections for microbiology (the study of bacteria and viruses), haematology (the study of blood cells), clinical biochemistry (the study of the chemical composition of the blood) and blood transfusion. Other laboratories carry out testing of tissue samples (histopathology and cytology).

At a Specialist Reference Laboratory

While most hospitals try to do as many tests as possible in the local laboratory, tests that are only rarely performed or that require special equipment or expertise may be referred to a specialist laboratory elsewhere in the UK (usually a regional or national specialist centre). Tests referred to such laboratories will usually take a little longer to process than those carried out locally.

Sources

Medicines and Healthcare Products Regulatory Agency: Management and Use of IVD Point of Care Devices. December 2013