Emergency departments (EDs) are under pressure due to growing backlogs created by the Covid-19 pandemic, staff shortages, changing population demographics, rising prevalence of chronic diseases and the spread of infectious diseases.
But during the Covid-19 pandemic, diagnostic testing on a mass scale helped to limit the spread of disease, and point-of-care (POC) testing accelerated the diagnosis and management of patients attending the ED. This success bred optimism that diagnostic testing both in the community and at the point of care will have an expanded role in healthcare in the future.
We commissioned a survey of 207 experienced ED-based healthcare professionals in the UK and the US, specifically doctors, nurses and paramedics. All of them are involved in POC as well as central lab diagnostic testing.
We explored their views about POC vs. central lab testing in emergency medicine; what other treatment areas would benefit from POC testing; and where beyond the ED respondents can see a role for wider adoption of POC testing.
What did we find?
ED-based healthcare professionals support POC testing and its expansion to a wider range of the illnesses.
A large majority (90%) agreed that POC testing was particularly well suited to the ED, due to its ability to provide rapid confirmation of diagnoses, thus allowing for faster triage and treatment initiation and reduced patient wait times.
As many as 85% also favoured greater use of POC testing for a wider range of illnesses. Septicaemia, infectious diseases and particularly respiratory infections were seen as the leading conditions for which POC testing would improve diagnostic and treatment decisions. However, they also considered POC testing to be important to evaluate acute presentations of more chronic conditions, such as heart disease and diabetes.
Central lab vs. point-of-care diagnostic testing
We also explored whether diagnostic tests would be better placed in central labs or at the point of care. ED-based healthcare professionals were in favour of POC testing – provided that the accuracy, reliability and turn-around times of specific assays don't stand in the way of POC implementation.
Typical responses included:
“Anything that can be POC should be.”
“If any test can be both accurate and reproducible, I see no reason it cannot be performed PoC.”
“POC could [be] incorporated into a small mini lab within the ED. [This] would reduce turnaround times.”
In line with the proviso, a significant number expressed reservations about the inferior accuracy (59%) of current POC tests, the scope for human error (53%), demand on ED staff time (37%) and a higher number of void or inconclusive tests (35%) when compared to central lab tests.
To a lesser extent, healthcare professionals saw the training required to be able to administer these tests (30%) and being able to only test for one marker/analyte at a time (31%) as drawbacks of POC testing.
We will discuss considerations arising from our survey for manufacturers of POC testing systems in a future blog.
Point-of-care testing in the community?
Interestingly, while ED-based healthcare professionals favour greater use of POC testing in the ED, they also see scope for wider adoption of POC testing beyond the ED.
In particular, up to 86% of ED-based doctors and nurses favoured POC testing being administered before patients arrived at the ED, with 71% believing that such testing should be performed at home before patients go to the hospital.
Large majorities also supported more POC testing in settings outside of secondary care, such as primary care doctors’ clinics (98%), long-term care homes (90%) and ambulances (93%) – to effectively initiate triage before a patient presents at the ED.
Find out more
ED-based healthcare professionals support the use and expansion of POC testing in emergency care, but they also see scope for wider adoption of POC testing in community settings to alleviate the strain on the front line of the healthcare system.
To learn more about the results of our survey, please download our report “A new era in point-of-care diagnostic testing: possibilities and practicalities”.