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Wednesday 28 September 2016
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Point-of-care testing

Article: Point-of-care testing

As point-of-care testing is becoming more and more accessible, it is important to consider how well prepared your practice is

Point-of-care testing (POCT) is not a new phenomenon; it dates back to the last century when clinicians would taste their patient’s urine at the bedside to help diagnose diabetes. Today the demand for accurate, simple to use POCT equipment to aid the management and treatment of a variety of conditions within primary care settings is becoming increasingly important. 

Not only can POCT improve patient outcomes by providing rapid access to patient results, it can also speed up the clinical decision-making process. The main advantage of POCT over conventional laboratory-based testing is that it removes sample transportation delays, but POCT testing is not without problems. 

Not only does it fail to deliver the economies of scale achieved by traditional pathology services, but by definition POCT encompasses any analytical testing undertaken in out-of-hospital laboratory settings, including those performed by non-medical personnel. It is here that there must be close liaisons with local pathology services in order to achieve safe, reliable and accurate results. 

Laboratory staff can advise on the selection of appropriate POCT equipment, assist with training, calibration and maintenance, and provide appropriate quality assurance schemes. 

By enlisting this help, primary care providers can ensure that comparable analytical results are consistently generated regardless of location. POCT schemes also have a key role to play in the latest NHS quality agendas, particularly in reducing the pressures on front line care. As a result primary care should implement community-based urgent care services to allow patients to have access to expert diagnosis, such as provided by POCT for example. Implementing POCT in community settings however presents many logistical challenges, and the new Metro-POCT facility at Manchester Metropolitan University (MMU) is now at the forefront of this.

Metro-POCT

A collaboration between MMU’s School of Healthcare Science and the NHS, Metro-POCT is a proof-of-concept project which aims to establish a one-stop POCT diagnostic training facility for community POCT practitioners. The dedicated POCT clinical skills studio (CSS) at MMU is managed through Metro–POCT in conjunction with the UK National External Quality Assessment Service (NEQAS) consortium and is led by Professor Keith Hyde, who was becoming increasingly concerned regarding the lack of POCT expertise in community settings and its potential impact on patient safety. 

The objectives of the project are to deliver competence in primary care POCT and to improve patient safety. This will be achieved by delivering POCT knowledge and learning to community POCT practitioners, who are typically practice nurses and healthcare assistants. Training covers aspects of POCT including sample handling, operation of devices and result reporting, all within the CSS at MMU itself. The training will be delivered by expert NHS Pathology professionals, supported by industry, this will ensure that the high quality work which takes place routinely in UK hospital laboratories transfers successfully to the community. The Metro-POCT project also dovetails into the current NHS quality agenda and the formation of the new clinical commissioning groups (CCGs) and is underpinned by research which ensures that content and training is not only ‘fit for purpose’, but that it ensures right content, right delivery, right language and right outcomes.

Lessons learned

Simon Kimber, National Project Manager for the Metro-POCT considers the project is making excellent progress and believes that the aim to roll out POC training and expertise to POC practitioners at MMU is on track. “Progress in year one went as planned, we commenced in November 2011 by recruiting in the necessary technical support and pathology and industry expertise we required. Initially we targeted areas including anticoagulation testing and cholesterol screening, as well as looking at ‘dipstick’ testing, but a vital area in any POCT scheme is to ensure that the EQA element is embedded within them as this plays a significant part in ensuring a high quality service.

An online survey was undertaken aimed at understanding the current awareness, uptake and attitudes to POCT in primary care as well as it’s potential impact in areas such as patient management and health economics. There were varied attitudes amongst GPs and practice managers towards its deployment, many of who were sceptical regarding its benefits and potential cost savings. It was POCT training, or rather, the lack of it, that was a major issue, it soon became apparent that there was no standardised approach to delivering POC training, as there were only limited local POCT co-ordinators available to perform this supportive role”.  

The project undertook its first pilot training and demonstration in June 2012 before finally opening the CSS itself at MMU in 2013, when it became fully functional. At the end of year one, many valuable lessons had been learned. “We realised that this wasn’t the best time to engage GPs and practice managers as it was a period of great change for primary care due to ongoing NHS reforms”. Because of the lack of clarity in some areas Metro-POCT began Year 2 by hosting a one day ‘Focus Group’ meeting of experts culled from a variety of backgrounds including pathology, the diagnostic trade, practice managers and a local CCG representative to act as a sounding board. Their verdict was “this is a great idea, but please get better engaged with your target audience and market needs”.

Reassured, Metro-POCT forged ahead by designing a training programme for community POCT users which aimed to assess various parameters such as quality, competence and user confidence as well as their general attitudes towards POCT as Simon explains. “We issued a questionnaire to local GP practices as well as visiting in person to talk directly with practice managers. Almost 50% of practices said that they were still actively considering some form of POCT in the near future, the main message was that the introduction of more POCT in primary care would provide a better service for patients.

Test and treat

Not only is POCT both practical and desirable it is in many cases essential, and the likelihood is that it will be incorporated into all areas of patient care soon as the technology advances in terms of ease of use and reliability. Consequently Simon Kimber considers that this is only the start of a potentially bigger project for Metro-POCT. “We held another Focus Group meeting in June 2013 which raised some interesting findings and challenged assumptions on our part. For example, many practice staff still are confused by the term ‘point of care testing’ and ‘near patient testing’, even though they are actually the same. Also we assume by introducing POCT we are improving patient care if we prevent repeated visits to the GP practice, but it seems many patients prefer to return for the reassurance this gives them over their treatment.

Long term, however, we hope to be able to repeat this model countrywide, MMU has an excellent facility for the in-house development of E-Learning and Apps for smart phones and tablets within its ‘Digi-Labs’ facility, one of which is already in the pipeline and will become part of the service offering to support the training programme. Our longer term objective is to provide embedded POC training courses resulting in more employable graduates, we also plan to develop both under graduate and post graduate health-related courses within MMU and also other at other universities. Vitally important however is that we engage with the new CCGs to ensure POCT training is offered as a fully commissioned, safe, reliable service”.