NEAR-PATIENT DIAGNOSTICS
improvement in the range of rapid tests available to clinicians. Thinking of the processes for requesting laboratory tests, it is clear that issues can and do arise.
Improving hospital-wide rapid testing Current processes mean that blood is drawn, labelled and sent to the laboratory. Responsibilities for that sample pass from person to person, and service to service. Once the sample leaves the requestor’s hand, the processes leading up to result availability are unknown and the time to result may not be clear. Essentially, clinicians waiting on those results to make care decisions are in the dark.
Relinquishing control can be a
problem for some. Rapid point-of-care diagnostics covering a wide range of tests could return that control to the care givers, empowering teams who can be highly trained to understand the equipment, interpret results, identify and troubleshoot errors. One thing is clear, if it is safe and effective to introduce wider profiles of tests, clinical teams should approach their organisations and demand improvements. Appropriate levels of governance and quality are a must, with pathology point-of-care teams traditionally providing this oversight from an operational and clinical perspective. How this may look in the future is something for debate, but it is unlikely that the current infrastructure across the healthcare landscape well enough is equipped to cope with rapid expansion, if the point-of-care discipline is better described and actively promoted.
Hot Labs
Many specialist areas such as intensive care units and emergency medicine have employed Hot Lab models for many years. A Hot Lab is a standalone service that provides a range of rapid tests independent of the medical laboratory. The equipment may facilitate testing not routinely provided in the medical laboratory and cover testing capabilities the laboratory does not offer. A range of acute and specialist equipment can enhance the care offered to patients in this setting.
Examples include acute care analysers that go beyond the scope of blood
The ubiquitous lateral-flow test, a now-common household medical device.
gases and offer a number of novel tests not offered in the medical laboratory. Examples include ionised calcium, ionised magnesium, haemoglobin fractions, along with ROTEM, TEG and other rapid coagulopathy tests. More recently we have seen an increase in rapid multiplex testing especially for detecting respiratory viruses, making point-of-care testing increasingly multidisciplinary in scope. The future of Hot Labs is dependent on the complexity of the services offered on site, and the knowledge and expertise required to run them effectively. Quality and governance need to be assured and appropriate oversight in place to review performance and advise on improvements.
Resourcing for the future: the knowledge and experience gap Point-of-care testing and rapid diagnostics are specialist areas of pathology, but development of the specific skills required to effectively deliver point-of-care services is not widely offered. In most cases a laboratory scientist or pathology support worker shows an interest in the
Acute care analysers offer a number of novel tests, including ionised calcium, ionised magnesium, haemoglobin fractions, along with ROTEM, TEG and other rapid coagulopathy tests
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subject and is offered an opportunity to experience what the service offers, which may lead to a substantive role. There are formal qualifications offered
through the Institute of Biomedical Sciences (IBMS) and the American Association for Clinical Chemistry (AACC) for point of care with varying levels of uptake. Within the UK NHS there are still no official national job profiles for point-of-care roles, with other profiles needing adapting and local job descriptions written to describe the duties and responsibilities. If these care delivery models, and the role of point of care within them, are expected to succeed then the profession needs to recognise the specialist skills that teams require. As a specialty, point-of-care testing needs equal standing with biomedical disciplines, with clear career paths within the medical laboratory professions.
References 1 NHS England. Diagnostics: Recovery
and Renewal. London: NHSE, 2021 (
https://www.england.nhs.uk/wp-content/ uploads/2020/10/BM2025Pu-item-5- diagnostics-recovery-and-renewal.pdf).
2 National Health Service. NHS Long Term Plan. London: NHS, 2019 (www.
longtermplan.nhs.uk/).
This article first appeared online (
https://poctinnovators.com) and is reproduced here by kind permission.
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