10 April 2019
The development of new technology means that point-of-care (POCT) testing is becoming increasingly widely used across the NHS and organisations are gearing up to provide an ever-wider range of POCT tests and services. POCT testing is defined as analytical tests performed outside of the laboratory setting by healthcare providers, such as nurses, midwives and other medical staff at the point of care.
So what are the advantages of POCT testing? The main advantage of POCT testing is that it leads to quicker diagnosis and treatment, resulting not only in an improvement to patient care but in many cases saving lives. POCT testing also provides financial advantages, for example it can reduce the need for return visits to GPs as results are available immediately and it can reduce the length of time a patient needs to stay in hospital or mean they don’t need to be admitted at all.
POCT at SWLP
POCT devices can be used in a number of settings; ICU departments, A&E, operating theatres, ambulances and in the community. However, the size and portability of the equipment means that POCT testing has the potential to be used anywhere, significantly changing the delivery of some pathology services. POCT testing devices are transportable, disposable and can be handheld.
When SWLP was formed, POCT was devolved across the three sites and was run by nursing and clinical staff, which caused issues around quality and compliance with ISO standards. SWLP brought the POCT service in-house in January 2017 and a new, harmonised service which is centralised at St Georges went live in June 2018. The new service was able to make savings for the three trusts of around £350,000 a year by creating central contracts with suppliers and harmonising the analysers and the procurement process, in addition to compliance with national standards.
In January 2019 the SWLP POCT team rolled out fully-networked thromboelstography analysers TEG6 in the emergency department, general ICU, cardiac ICU and cardiac theatres. This will help guide clinicians in treating major haemorrhages and administering blood products.
The POCT team is made up of five people led by POCT Manager Haval Ozgun. The team, while based at St George’s, spend their time working across the four sites covered by SWLP. The team introduced POCT testing to RNOH from scratch in 2017 and are currently working with staff at New Victoria Hospital to make sure they are trained and ready to go live with their new POCT service at the beginning of April.
How POCT is changing pathology
Flu testing is an excellent example of how POCT is changing healthcare. POCT meant that flu A/B could be diagnosed in emergency departments more than 24 hours earlier so patients with flu could be isolated very early reducing the risk of cross-infection to other patients. Likewise, identifying patients with negative flu results avoided unnecessary isolations and anti-viral treatment, thus utilising the isolation bays more efficiently. During the last flu season, St Georges Hospital was able to create a dedicated flu ward because of POCT testing, which reduced the hospital-acquired infection rate for flu and reduced the average hospital stay for flu patients. SWLP was the first in the country to set up POCT in the emergency department to support flu diagnosis and management.
POCT is set to become more important for pathology services in the future. Increasingly, clinicians will expect POCT to go hand-in-hand with and compliment main lab solutions. There will also be moves to use POCT outside of hospital settings. For example, urgent care centres could use POCT to diagnose and treat patients without the need for them to visit A&E and GPs are increasingly interested in using POCT within their surgeries to speed up diagnosis and reduce the reliance on traditional labs. Led by our excellent POCT team, SWLP is at the forefront of these exciting developments.