POINT-OF-CARE TESTING
care testing instrumentation, particularly the assay provided by QuidelOrtho: TriageTrue High-Sensitivity Troponin I. The TriageTrue’s analytical performance has met the relevant criteria for a high sensitivity assay and the clinical diagnostic efficiency is excellent. We see the implementation of such point-of-care testing (POCT) technology as breaking the logjam in assessment of patients with chest pain.
Considering your expertise and experience, what advice or recommendations would you offer to the NHS moving forward? PC: Implementation of point-of-care testing for cardiac troponin is not without its challenges. The clinical evidence of diagnostic accuracy is now very solid. Evidence for efficacy is currently more limited, although two trials that are currently underway suggest that significant reductions in time in the emergency department (patient length of stay) can be achieved. In order to move forward the most essential thing is to form a multidisciplinary team that can implement this technology whilst acknowledging that delivering high- sensitivity troponin by point-of-care testing is a more expensive and a more challenging option versus simply sending the sample to the laboratory. It must be accepted that not only is the analytical cost higher but there is a staffing cost of implementing a safe analytical system at the point of care. It is vital that rapid assessment pathways are defined that will hinge around the rapid provision of an ECG and troponin result as soon as the patient arrives in the emergency department. Most importantly, this information must be then acted on immediately by a competent decision-maker. There is a clear role here for a different staffing mix who can potentially be rapidly trained to do the initial assessment of the patient, the formal investigations and then present the results. It must be remembered that these patients do not have to be put on a bed but can be managed in an ambulant chest- pain facility.
The knock-on effect in terms of
improvement in patient flow as well as reducing hospital admissions should be appreciated. Ultimately both of these efficiencies will reduce overall hospital costs. And the improvement in quality both in terms of impact on morbidity and mortality, as well as the patient experience, is beyond any monetary figure.
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Professor Paul Collinson is a leading expert in cardiac biomarkers, known for his impactful research and contributions to healthcare diagnostics. He previously served as a consultant chemical pathologist at St George’s University Hospitals NHS Foundation Trust and is a professor at St George’s University of London. His clinical interests include hyperlipidaemia, cardiac disease prevention, and complex lipid disorders. Professor Collinson has been instrumental in advancing cardiac biomarkers in the UK and served as an advisor to NICE. A prolific academic, he has shared his expertise through publications, lectures, and collaborations, shaping the future of healthcare globally.
Any strategy which aims to improve patient flow should be fully embraced and funded, once proven to be clinically effective
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