Are there tangible benefits to be gained by increasing the scope and availability of point of care testing (POCT)?
Charlie Houston, Laboratory Sector Manager, NHS Greater Glasgow and Clyde.
YES
POCT is used in many places. These include critical care units, emergency departments, respiratory medicine outpatient departments, community respiratory services and air ambulance retrieval units. And this list is not exhaustive.
There may be some benefits in increasing the scope and availability of POCT by making some laboratory tests available in a POCT setting. Recent examples would be C-reactive protein used in GP practices to determine antibacterial use in respiratory tract infection, and brain natriuretic peptide in emergency departments, used as a decision-making tool in heart failure.
Others included home testing for sexually transmitted diseases, malaria screening performed as a POCT in underdeveloped countries and respiratory syncytial virus testing for triage. There are many tangible benefits, if used correctly. However, POCT testing introduces many challenges, particularly with governance issues, such as quality control and quality assurance, as POCT is generally performed by busy members of the clinical team, not by laboratorytrained individuals.
Non-laboratory-trained individuals often lack an understanding of the importance of quality control and quality assurance. POCT testing is also, in general, more expensive than traditional laboratory methods and it may therefore depend on whose budget funds the test.
Rhys Tassell, Team Leader – Point of Care Testing, Cambridge University Hospitals NHS Foundation Trust
YES
Yes, on a number of levels. We already know that, if controlled properly, POCT has benefits that are measurable in terms of reduction in drug costs, length of stay, keeping to theatre list targets and reducing the time taken to admit or discharge a patient in an emergency department, to name a few.
Emergency treatment decisions via POCT by A&E staff can reduce emergency admissions, and hospital attendance could be further reduced through POCT by paramedics, GP surgeries, minor injury units and pharmacies. Proactive health monitoring schemes and screening, such as NHS Health Checks and chronic condition management, make healthcare more personal.
More routine tests at the point of care would mean a reduction in overloading capacity in some routine labs, but would still need biomedical science staff to govern and oversee use of such equipment.
We are proof that the biomedical scientist role is still very much needed when a trust invests in delivering a comprehensive and robust POCT service. I think there is more central government control required over POCT availability to the general public.
From personal experience of individuals arriving in the department with devices they have purchased needing advice, little is done to educate people who are purchasing kits off the shelf in retail outlets, or through the internet.
David Ricketts, Head of Laboratory Process Improvement Health Services Laboratories LLP
YES
Yes, there are benefits to expanding POCT. Any expansion needs to play a key part in patient pathways. There are areas of great interest in ambulatory care, using POCT to help prevent overnight admission, for example. POCT without linking into improved decision-making in the patient journey adds no value over traditional laboratory support though.
The quality of these services will ultimately influence these benefits, with good laboratory support being key to this.
