Equitable and timely access to diagnostics is critical to delivering effective urgent community response (UCR) and virtual ward services. Point of care testing (PoCT) offers one way to achieve this.
The national delivery plan for recovering urgent and emergency care services encourages integrated care boards (ICBs) and providers to consider using PoCT for both virtual ward and UCR services.
This guidance provides information on the key requirements to support integration of in vitro diagnostic (IVD) PoCT devices into these services. It also outlines the role of pathology and considers organisational governance and clinical safety responsibilities.
For virtual wards and UCR we recommend that this guidance is read alongside:
- Supporting information: virtual ward including hospital at home
- Acute respiratory infection virtual ward guidance
- Frailty virtual ward guidance
- A guide to setting up technology-enabled virtual wards
- Two-hour urgent community response standard guidance
The integration of PoCT into your service should also be considered within your service’s health equality impact assessment.
This guidance was developed with a range of professionals at local and national level, cited within the acknowledgements.
1.1 In vitro diagnostic point of care testing explained
PoCT is any analytical medical testing that is performed at, or near to, the site of the patient, aiding rapid clinical decision-making and potentially leading to a change in the care of that patient [1–3]. Typically, PoCT results are available at point of care within seconds up to about 20 minutes.
The purpose of a PoCT service is to enable the delivery of high quality, accessible diagnostics at the point of need for clinical services, improving clinical outcomes and enhancing patients’ healthcare experience .
As with all diagnostics , PoCT can include a range of types of tests that:
- rule a specific disease in or out
- enable general examination, providing clues to the cause of a patient’s symptoms
- help with disease staging, assessing how advanced or severe the disease is
- monitor a patient’s condition over time to identify changes
- screen asymptomatic patients for a specific condition.
The focus of this guidance is IVD PoCT diagnostics; these perform tests on a sample taken from the body, such as blood or urine, outside the body. In a laboratory environment this would most likely be in a test tube . IVD PoCT devices are under the remit of pathology.
The evidence shows that the availability of rapid results from IVD PoCT devices used in the community can support better clinical decision-making, including helping to avoid unnecessary hospital admissions . Overall, when compared to laboratory testing, IVD PoCT devices are as accurate and reliable . Clinicians should be confident in making decisions based on these PoCT results, so long as the devices are used in the way they are intended to be, and clinicians understand the tolerances and limitations of devices and results (see section 4: clinical risk management, and section 5: training).
To successfully use and implement IVD PoCT it is critical to engage your pathology department early in the journey, in particular to ensure that the clinical safety requirements are met (see section 4: clinical risk management).
We also recommend you access your pathology network’s handbook; this will tell you all about each available test including the quality standard, the reference range and the test applicability. Please contact your pathology network or local pathology laboratory for more information.
All PoCT devices must be registered and regulated by the Medicine and Healthcare products Regulatory Agency (MHRA) and carry a UKCA mark. (Note: subject to parliamentary approval, we expect that the CE marking will be recognised until certificates expire or 30 June 2030, whichever is the sooner). Further information is available in Regulating medical devices in the UK).
For further detail on points 1 to 7 please see the annex.
2. Diagnostic models of care
In considering what the optimal diagnostic offer for your service is, and whether to include PoCT, thinking about the purpose of the diagnostic test can help:
- What do you need that test to tell you?
- How quickly do you need the result – to be able to make the best clinical decision, for that patient’s care, at that point in time?
- What is the situation within which you are operating?
This will help you identify whether using a PoCT device might help improve outcomes.
This section includes examples from UCR and virtual ward teams who have integrated PoCT to optimise their service’s diagnostic offer.
2.1 Supporting assessment by urgent community response teams
UCR services provide urgent assessment, treatment and support to adults at risk of hospital admission in their homes – usually older people or adults with complex health needs – within 2 hours, avoiding the need to admit them to hospital. UCR can provide access to services such as physiotherapy and occupational therapy, medication prescribing and reviews, and help with staying well-nourished and hydrated.
Often this includes frail adults, particularly those who have fallen and/or are newly confused, who can be complex to assess. For example, a person with an acute underlying condition, such as sepsis, and one with dehydration can often present in a similar way. Evidence shows that unnecessary conveyance and admission to hospital can risk their loss of independence and function, and medical deterioration .
Using PoCT to support community assessment of frail adults can significantly improve clinical decision-making and patient outcomes . The key considerations are:
- PoCT devices are for use by clinicians in an individual’s home, including a care home, or community location.
- Models vary from UCR teams, advanced paramedics to healthcare assistants with an on-call doctor in a hub providing clinical supervision. All clinicians must be appropriately trained (see section 5: Training).
- The purpose is to aid clinical decision-making when it is not clear from standardised assessments whether a patient should be conveyed to hospital, treated on scene, admitted to a virtual ward or discharged to primary care. This is particularly helpful for frail adults.
- PoCT devices need to be light and easy to carry, alongside the other kit that the medical team will be taking with them. Depending on the device requirements, sometimes they are carried in a special temperature-controlled bag.
- Existing services identify the following as the priority tests for implementation:
- blood glucose and ketones
- C-reactive protein (CRP)
- haemoglobin and haematocrit
- renal profile, commonly known as urea and electrolytes (U&E)
- venous blood gas analysis (VBG).
For further detail on points 6 and 7 please see the annex.
Case study: Frimley Health NHS Foundation TrustWorking with pathology Frimley Health NHS Foundation Trust has integrated PoCT in both its UCR and virtual frailty ward, to aid clinical management through rapid diagnostic testing in the patient’s home. The deployed kit includes tests for CRP, U&E, VBG, including pH, PCO2 (partial pressure of carbon dioxide) and lactate.
This has had a significant impact on the assessment of adults living with frailty and/or multiple co-morbidities. Previously, under standard observations and assessments, a large proportion of people would have been conveyed, but the trust can now provide acute hospital-level treatment and support them at home.
Patients requiring urgent diagnostic testing can now be seen and clinically assessed at home within 2 hours and have treatment started; if appropriate, the team will admit them to the frailty virtual ward service.
As a result of using PoCT, the trust can now provide appropriate treatment to patients with multiple organ failure such as heart and kidney failure in their homes, managing their symptoms of fluid overload. For example, with access to real-time results on kidney function, clinicians now know whether to change the intravenous diuresis dose and can do so immediately.
Contact Fhft.firstname.lastname@example.org for further information.
2.2 Supporting management on virtual wards
Virtual wards support patients who would otherwise be in hospital to receive the acute care, remote monitoring and treatment they need, in their own home or usual place of residence.
The main PoCTs virtual ward providers are typically using to aid clinical decision-making are:
- blood glucose and ketones
- C-reactive protein (CRP)
- haemoglobin and haematocrit
- influenza and COVID-19
- international normalised ratio (INR)
- renal profile commonly known as urea and electrolytes (U&E)
- venous blood gas analysis (VBG).
PoCT is an area that is constantly evolving; what is available now is not static or fixed. The types of PoCT required differ by type of virtual ward; for example, heart failure virtual wards may also include N-terminal pro B-type natriuretic peptide (NT-proBNP). See the virtual ward FutureNHS page for further examples.
Case study: City Health Care Partnership CIC, Hull and East Riding of YorkshireCity Healthcare Partnership CIC provides a joined-up frailty virtual ward and UCR service, which is also integrated in 111, 999, as well as proactive care. Its model of care uses a team of frontline healthcare professionals (primarily Band 3 clinical support workers, as well as paramedics and advanced nurse practitioners) who visit patients at home. Their decision-making and PoCT result interpretation are supported by a remote hub staffed by consultants and GPs specialising in frailty.
The team use a range of PoCT devices: portable, handheld IVD PoCT (blood glucose and ketones, CRP, haemoglobin and haematocrit, lactate, U&E, VBG); a bladder scanner; ECG; a digital stethoscope and high-definition camera to carry out remote examination. The latter uses bluetooth and middleware to save results to the patient’s EPR.
Contact email@example.com for further information.
Case study: Oxford University Hospitals NHS Foundation TrustThe trust has integrated PoCT to aid clinical decision-making on its virtual ward ‘Acute Hospital at Home’ service.
The service uses a blend of virtual and face-to-face assessment and treatment of patients on the frailty virtual ward. Frontline healthcare professionals (nurses, advanced paramedics, physicians) visit patients at their home (including care homes) to carry out diagnostic tests using PoCT devices (blood tests, physiological measurements and imaging), to inform management, such as intravenous treatment.
In addition, some patients are supported to carry out self-monitoring if required. All patients are monitored both in person and virtually via the Acute Hospital at Home team.
Contact AOT@ouh.nhs.uk for further information
3. Expected benefits of point of care tests
The expected benefits for UCR and virtual ward teams include:
- quicker and more effective clinical decision-making [8, 9]
- better antibiotic prescribing and antimicrobial stewardship [8, 9]
- improved patient satisfaction and quality of life 
- significant cost savings to the NHS 
- significantly reduced conveyance to hospital of adults with frailty syndrome (20% – 50%) [6, 8, 10, 11]
- reduced re-contact rates for frail adults following discharge on scene, in comparison to usual care .
For further detail on points 6, 8, 9, 10 and 11 please see the annex.
4. Clinical risk management
4.1 Clinical risk management through service design
Implementing PoCT within UCR and virtual ward services requires consideration of the following elements regarding managing clinical risk:
- Within your ICB, ensure that the integration of PoCT fits within your overarching system-wide governance of UCR and virtual ward services, both service management and clinical assurance. For additional supporting information, see guidance for supporting clinical leadership in virtual wards and virtual ward and urgent community response capabilities framework.
- Ensure that all key professionals are involved in the design for integration of PoCT into your care pathways. Specifically, we recommend involving your clinical teams, local pathology lead and digital from the start. Care pathway design must also involve patients who use the service and patient safety partners (see Framework for involving patients in patient safety).
- Ensure that your service has access to pathology to support the integration of PoCT into your service. Depending on how your service is structured, your ICB may need to explicitly contract pathology to support your service to use PoCT. This is usually via direct access or a service level agreement.
- Specify the knowledge, skills and competencies clinicians require to perform the tests, interpret their results and carry out quality assurance.
- Specify the operating procedures, including an escalation procedure that provides guidance on what operators should do if they have further questions or need additional assistance.
- As part of your operating procedures, develop a clear flowchart to support clinical decision-making and subsequent actions related to patient care.
- Consider the potential for error in relation to using PoCT devices and their assays (sometimes called cartridges or test strips); for example, using the wrong test strip or reading the wrong value. How well are the assays labelled (to ensure the clinician uses the right one) and how does the device display the results, particularly where there are multiple values?
- When including self-administered PoCT devices, establish safety netting advice and escalation plans for patients; these are usually covered in the onboarding processes.
- Ensure data recording is in place, with traceability to both the device and clinician operating it, for audit purposes.
- Ensure that there is a clear protocol for the recording of a patient’s test results. It will be important to consider who needs to be able to view the results, and therefore both where they need to be stored and be accessible from.
- Preferably, the device results will be automatically transferred to the laboratory information management system (LIMS), the relevant electronic patient record (EPR) and the shared care record (SCR). This is often possible using middleware (a software bridge between two systems), but in less digitally mature areas, professionals may need to manually enter results.
- Where possible the patient’s shared care records should be accessible virtually by the professionals caring for the patient. This can improve clinical decision-making as test results can be compared, and give access to patient information on medication .
- Depending on local requirements, internet connectivity for clinicians when visiting a patient may need to be considered.
- Information governance is another important consideration; a data protection information agreement (DPIA) will be required for any electronic transfer of data.
For further detail on points 7 please see the annex.
4.2 Clinical risk management through PoCT device set up and management
PoCT devices need to be appropriately validated, calibrated and maintained. This is critical to managing clinical risk.
- All PoCT devices must be validated by pathology according to the United Kingdom Accreditation Service (UKAS) standards. Point of care testing (POCT) accreditation provides further information.
- Pathology will need to lead the validation of PoCT devices, ensuring that they meet required ISO standards: ISO 22870; ISO 11073; ISO/AWI TS 7122; ISO 15189).
- Pathology should have overall responsibility for the management of relevant devices and oversight of the frequency of quality checks. A protocol is needed for what to do if a PoCT device fails its internal quality control (IQC) check.
- External quality assessment (EQA) registration will be needed to assure ongoing quality of results, as well as audit of pathology tests – horizontal, vertical and witness audits, as required by the accreditation process and contractual requirements.
- PoCT devices need to be calibrated and maintained as set out by the manufacturer – without this, the devices should not be used.
- Who performs assurance tests and sets up PoCT devices before use needs to be clear in guidance.
- PoCT devices must be used according to their information for use (IFU), including appropriate calibration and storage.
- PoCT devices should be subject to ongoing quality assessment. PoCT device results must have scientific oversight from the local pathology network healthcare scientists. This includes IQC and EQA scheme registration.
Storage and usage
- PoCT devices and assays need to be stored appropriately. This may include in a fridge or a specially designed lab kit bag; the manufacturer will set out the required specification in the information for use (IFU) for medical devices. Pathology can provide advice and guidance on this.
- Who has oversight of the devices/strips/cartridges used needs to be agreed, in case of device/product recalls; usually this is pathology.
Clinical safety and reporting
- Specify who the chief clinical information officer/clinical safety officer is for risk assessment of implementation of device/software application as per DCB0160: clinical risk management: its application in the deployment and use of health IT systems (NHS Digital).
- The device manufacturer should provide you with the DCB0129 for the device.
- Report any issues with device safety, or patient safety incidents relating to any aspect of PoCT, to the organisation’s local risk management system and ensure that information is also shared via the national reporting and learning system or its successor, the Learn from Patient Safety Events Service. Medical device issues also need reporting to the MHRA yellow card system.
- Management of and response to any patient safety incidents related to PoCT should form part of the organisation’s wider clinical governance/risk management activities. From autumn 2023, all organisations providing care under the NHS Standard Contract are expected to plan for and respond to patient safety incidents in line with the Patient safety incident response framework.
- If using other physiological or imaging devices, such as ECG, bladder scanning, blood pressure monitors and pulse oximeters, clinical engineering input will be required.
- The accreditation scheme is different from that used in pathology: Quality Standard for Imaging (QSI), Improved Quality in Physiological Services (IQIPS) version 2 and Medical Physics and Clinical Engineering (MPACE) accreditation for radiotherapy physics.
5. Training for frontline healthcare professionals
Pathologists who are currently delivering these services advise that clinicians who are using PoCT devices with patients receive training in:
- the clinical care pathway
- use of PoCT devices and the related assays
- calibration and quality control of devices
- interpretation of results
- safe disposal of cartridges and consumables, and devices following contamination
- storage of devices and cartridges (temperature/exposure to sunlight)
- expiry date check
- decontamination between uses; to prevent inaccurate results from, for example, splashed blood, urine or sputum
- clinical escalation protocols
- where and how to record results
- patient safety incident reporting and response
- level 1 Essentials of patient safety training
- yellow carding to MHRA.
Usually, this training is designed and delivered by pathologists locally or by the device manufacturers. Training should be documented and a record maintained; ongoing training updates will be required.
The guidance on Point of care testing in community pharmacies also contains information on training.
6. Roles and responsibilities
We recommend the following roles and responsibilities for setting up and running a community health service that uses PoCT.
- Work with clinical staff to develop the care pathway. Depending on how the service is set up, this may require pathology to be explicitly commissioned by the ICB to provide the required support.
- Work with clinical, procurement and digital teams to develop procurement specifications for PoCT devices, any supporting infrastructure such as lab kit bags or fridges, and digital interoperability requirements, particularly in relation to results management.
- Validate and set up of devices to relevant standards.
- Oversight of protocols and adherence to quality assurance of devices and assays, including device calibration and maintenance.
- Train clinical staff, including in re-validation protocols.
- Lead on clinical safety aspects and lessons learnt.
- Work with digital and clinical staff to determine how test results should be recorded and accessed by key professionals, including transfer to LIMS, relevant EPRs, shared care record and any required software to facilitate this.
- Input into evaluation of impact (this could include leading the service evaluation).
- Overseeing incidents and incident reporting.
You may find the following guidance useful:
- NHS England – Point of care testing in community pharmacies guide
- Management and use of IVD point of care test devices – MHRA
- ISO 15189:2022 – Medical laboratories – Requirements for quality and competence
- Point of care testing, guidance on the involvement of the clinical laboratory – IBMS
6.2 Clinical staff
- Work with pathology, clinical safety and digital staff to develop the clinical care pathway for integrating PoCT into your service.
- Work with pathology and frontline healthcare professionals to identify the best lightweight, portable PoCT devices for the model of care; and also with procurement and digital to ensure the correct devices and any infrastructure are procured and set up.
- Work with digital and pathology to determine how test results will be recorded and accessed by key professionals. For example, use middleware for direct transfer of patient results from the PoCT device to the patient’s EPR and any other required systems, for example, pathology’s LIMS system. Lack of remote digital interoperability should not be a barrier to using PoCT, but results would then need to be manually entered into the identified record keeping system.
- Recruit/identify frontline healthcare professionals with appropriate skills and competencies to deliver the service; ensure that they are appropriately trained/
have access to continuing professional development.
- Lead or support data gathering and evaluation of impact.
6.3 Digital staff
Consider who will need access to the patient’s PoCT results and ensure they have this via the relevant systems; these will most likely include your virtual ward patient dashboard, pathology LIMS, the relevant EPR and potentially the SCR with primary care.
Frontline healthcare professionals may also find it helpful to be able to see their patient’s SCR as results from tests carried out by primary care can inform their ongoing clinical assessment.
Digital staff should work with pathology and clinical staff to identify how test results will be recorded and accessed by key professionals, and any required software to facilitate this, such as middleware for their direct transfer.
Data Protection Information Agreements (DPIA) will be required to ensure appropriate governance over the transfer of patient data. You will also need to work with your clinical safety team, to ensure that any digital-related clinical safety risks are appropriately managed (see section 4.2: clinical safety and reporting).
Not having the digital capability to automate upload of results to appropriate clinical information systems should not be a barrier to using PoCT. However, consideration will need to be given to how the results can best be recorded/made available in the appropriate systems and whether any local validation or approval process will be needed for this.
You may find the following guidance useful:
- A guide to setting up technology-enabled virtual wards – key tools and information – NHS England
- Clinical risk management training – NHS Digital
Costs to consider when integrating PoCT into a UCR or virtual ward service are:
- PoCT devices
- IQCs and EQA registration
- fridge and/or lab kit bag (if temperature control is required)
- middleware for digital interoperability to transfer test results from the device to where the relevant patient data is stored – that is, LIMS, EPR etc (depending on level of digital maturity)
- remote internet access and a device to access the SCR/EPR on site (depending on level of digital maturity)
- pathology time, for example, validation, training, ongoing oversight of quality control
- clinician time, for example, delivery of service including quality control and clinical oversight
- evaluation (service/impact).
In terms of procurement of PoCT devices, developing a clear specification and involving pathology will help ensure that devices are fit for purpose.
For help with procurement of IVD PoCT, you may want to make use of NHS Supply Chain’s pathology and point of care testing. NHS Supply Chain lists test suppliers and can also help with the development of a more bespoke specification and support you with either direct award or running a mini competition.
8. Evaluation recommendations
Use of PoCT should be evaluated to ensure clinical safety, support service improvement and build evidence on use of PoCT as a community intervention. Example key indicators are listed below.
8.1 Clinical safety evaluation
All services should evaluate the clinical safety aspects of using PoCT devices, as a minimum. For example:
How often were specific tests/devices used?
- Test frequency by operator?
- How many staff regularly used the product?
- Which staff used the product? (the specific operator, type of staff and grade)
- How many reagents were wasted due to being out of date or inappropriately stored?
Internal quality control frequency
- Was the IQC run in accordance with standard operating procedures?
- Were the IQC results acceptable?
- Was the device registered with an EQA scheme?
Test failure rate
How often did devices fail to produce a result?
What caused the devices to fail to produce a result?
Device down time
How often were the devices out of action?
Patient safety issues
Any reported patient safety issues, including incidents where devices have not worked as expected and intended, and those where the device is inadvertently used in an incorrect way?
For clinical evaluation, we also recommend reviewing:
- Point of care testing: national strategic guidance for at point of need testing – Institute of Biomedical Science (ibms.org)
- Management and use of IVD point of care test devices – gov.uk (www.gov.uk)
8.2 Service evaluation
Measuring the impact of use of PoCT devices on clinical and quality of life outcomes in comparison to usual care, as well as return on investment, is important to support building the evidence base in this area.
- Professionals using the devices.
- Numbers of patients for whom devices used.
- Patient demographics (age, gender, ethnicity, postcode/index of deprivation) – to understand the impact on heath equity.
- Presenting complaint.
- Relevant medical history.
- Initial diagnosis and decision from standard observations and assessment (including convey to hospital, admit to virtual ward, refer to primary care, treat on scene and discharge).
- If PoCT was deployed, which tests were used (for example, lactate, CRP, U&E).
- If PoCT was not deployed, record the reason why, to evaluate the effectiveness of the pathway.
- Diagnosis and clinical decision following use of PoCT, including how this may have changed the decision (including convey to hospital, admit to virtual ward, refer to primary care, treat on scene and discharge).
- Whether any treatment is given on scene, including details, for example, hospital-level processes of care including medications initiated (oral/intravenous) and changed.
- Changes in clinician confidence in decision-making.
- Changes in clinician satisfaction.
- Patient confidence in decision-making/satisfaction with outcome.
- Patient and clinician testimonies.
- Follow-up – re-contact rates for those discharged/treated at scene/referred to primary care or other services (and comparison to standard care).
- Follow-up – those conveyed to hospital (admission/length of time, etc).
- Follow-up – admission to virtual ward (length of time and outcomes).
Management on virtual wards
- Use of PoCT (and related technology enablement), when and what.
- Impact on clinical decision-making, including treatment.
- Change in clinician confidence in decision-making and satisfaction/morale.
- Patient confidence in decision-making/satisfaction with outcome.
- Patient and clinician testimonies.
- Length of time on virtual ward and outcomes.
- Follow-up, such as re-contact rates, re-admission, etc.
Your local academic health science network (AHSN) may be able to help with evaluation. Where possible, we encourage publication of both process and impact evaluations. (Please note that from October 2023 AHSNs will be called health innovation networks).
- ISO 15189:2022, Medical laboratories – requirements for quality and competence
- Institute of Biomedical Science, Point of care testing (near-patient testing) guidance on the involvement of the clinical laboratory
- Institute of Biomedical Science (2004) Point of care testing: national strategic guidance for at point of need testing
- National Institute for Health and Care Excellence (NICE) Diagnostics Assessment Programme
- World Health Organization In vitro diagnostics (definition).
- Novak A, Cherry J, Ali N, et al (2022) Point-of-care blood testing with secondary care decision support for frail patients. Journal of Paramedic Practice
- Verbakel JY, Richardson C, Elias T, et al (2020) Clinical reliability of point-of-care tests to support community based acute ambulatory care. Acute Medicine 19(1): 13-22.
- Royal Cornwall Hospital NHS Trust (2021) Final report for the trial implementation of point-of-care testing, Cornwall 111 and Kernow Health CIC – virtual wards network – FutureNHS Collaboration Platform
- Riddoch FC, Gash G, Abbott L, and Heaney K Berkshire and Surrey Pathology Services and Frimley Health NHS Foundation Trust (2023) Clinical impact of PoCT CRP testing in the hospital @home service
- Hart J, Oxford AHSN (2021) Opportunities for point of care testing.
- Heaney K (2020) Point-of-care testing by paramedics using a portable laboratory: an evaluation. Journal of Paramedic Practice
This guidance has been developed with the following NHS England specialty teams: Office of the Chief Scientific Officer, diagnostic digital capabilities, diagnostic policy, digital health, imaging, national clinical engineering network, NHS @home, national patient safety, national ambulance, pathology, pathology information standards; physiology, terminology and classifications delivery service, virtual wards and UCR.
Special thanks to:
- Dr Anna Folwell, Consultant Community Geriatrician, City Healthcare Partnership CIC, Hull and East Riding of Yorkshire
- Professor Daniel Lasserson, Clinical Lead – Acute Hospital at Home, Oxford University Hospitals NHS Foundation Trust
- Gemma Gash, Advanced Clinical Practitioner, Frimley Health Foundation Trust
- Helen Hobba, Senior Biomedical Scientist POCT, Royal Cornwall Hospital Trust
- Julie Hart, Diagnostics Pathway Transformation Specialist, Oxford University Hospitals NHS Foundation Trust/Oxford ASHN
- Katy Heaney, Consultant Clinical Scientist, Frimley Health NHS Foundation Trust
- Dr Keith Ison OBE, FIPEM
- Paul Hebdon, Programme Manager, Community Development, Med-Tech, Digital and Data-flow, NHS England – South West
Annex: A summary of the evidence for the benefits of using PoCT devices in the community
Improved confidence in clinical decision-making
PoCT increases clinician’s confidence in making decisions. One study showed that following a standard assessment, clinicians were unsure of the patient’s disposition in 85.6% of cases; after using PoCT their confidence (of patient disposition) improved in 75.6% of these cases; which then led to a subsequent increase of 84.6% in clinician confidence in decision-making .
The same study showed how use of a PoCT enabled a change in decision-making: 10% of those who would have remained at home under standard decision-making were conveyed to hospital due to the severity of their underlying condition.
Quicker clinical decision-making
PoCT enables faster decision-making and clinical intervention.
Significant reduction in conveyance to hospital
PoCT may help clinicians quickly detect or rule out serious illness; they can then, in conjunction with patients, make faster, better decisions about care and management, and avoid unnecessary conveyance and hospital admission.
Pilot studies show improved clinical decision-making reduces hospital conveyance rates by 20 – 50% for this patient cohort of adults with frailty syndrome [6, 10, 11].
One study demonstrated statistical significance for clinician confidence in deciding not to admit based on PoCT results; 70.4% of admission avoidances were assisted by the PoCT .
Enable good clinical management on a virtual ward at home
PoCT can enable management of patients at home, who would otherwise need to be admitted to hospital bedded care.
One pilot study on the use of PoCT CRP showed that in 12 patients (45%) POCT CRP avoided an additional visit from the virtual ward team the following day. In 13 patients (50%) POCT CRP improved the safety of care and helped avoid the need for escalation to hospital care, at a cost of up to £3,914 per patient .
Reduction in re-contact rate following discharge on scene
Pilot studies show that where PoCT devices are used to aid clinical decision-making, those discharged on the scene have a lower re-contact rate in comparison to usual care. For example, in a south-central Ambulance Service pilot, the re-contact rate within 7 days was 11.5%, compared to 14.67% for usual care .
Supports antimicrobial stewardship
PoCT can improve antimicrobial stewardship by distinguishing a likely bacterial infection from a viral one, reducing over prescribing of antibiotics and risk of antimicrobial resistance [8, 9].
Representative of a wide body of strong evidence, a pilot in Cornwall reported that the use of PoCT, specifically for CRP, influenced the decision to prescribe in 88 (59.86%) patients .
A pilot study on a frailty virtual ward showed that the use of PoCT CRP changed the antibiotic decision in 6 patients (23%), of whom 4 were de-escalated from IV to oral antibiotics, and 1 from IV to no antibiotics. 1 patient would have been escalated from oral to IV, meaning the right treatment would have been delivered sooner .
NICE’s guideline [CG191] on the diagnosis and management of pneumonia in adults recommends that PoC CRP testing should be considered for people with symptoms of lower respiratory tract infection in primary care if a diagnosis is unclear after clinical assessment, and that antibiotics should be prescribed based on the result.
Increased patient satisfaction and quality of life
Patients can be seen, tested and results explained to them on the scene. This enables clinicians to reassure a patient and helps inform personalised care decisions and shared decision-making on next care steps.
One study shows that people treated for acute conditions in their home have higher rates of patient satisfaction of care .
Cost savings to the NHS
South Central Ambulance Service’s evaluation suggests the trust could save circa £10 million a year if it used this model of care at scale , and the NHS overall £138 million a year.
Gemma Gash, Advanced Clinical Practitioner, Frimley Health NHS Foundation Trust“The service has found that most patients do not want to go to hospital; they want to stay in the familiar environment of their home. Also, the statistics show that frail adults do not thrive during admission, with muscle wasting and reduced mobility starting while in A&E.
Access to real-time results in the patient’s home means I can better care for them. This has boosted my and my team’s morale and sense of achievement. It has improved our clinical care, reassures the patients and family members immediately, and cemented our clinical assessments. Our work has been recognised by the trust with a VIP award following a patient’s recommendations. The trust is seeing real benefits from reduced A&E attendances and length of stay from our work to facilitate early discharge”.
Dr Anna Folwell, Consultant Community Geriatrician, City Health Care Partnership CIC, Hull and East Riding of Yorkshire“The team have found that integrating PoCT in our service model has given our clinicians more confidence in the decisions they make, as well as building trust with our patients, their family or carers.
We’re able to proactively keep people out of hospital while providing them with hospital-level care at home. We were called to a care home to see an individual in their late 80s with dementia who had diarrhoea and vomiting but were managing some oral fluids. The family questioned if hospital admission was required. Use of PoCT allowed the team to demonstrate to the family that the patient was not dehydrated and could be safely managed in the care home, which was their preference.
A man called 111 with ongoing symptoms of a urinary tract infection (UTI) and blood in his urine. Following a telephone assessment our clinical support worker visited him at home where they further assessed him using a bladder scanner. This showed that while he was passing some urine, 500mL remained in his bladder. He was also constipated, and this was aggravating his UTI symptoms. We treated him with antibiotics and laxatives and followed up with a visit the next day to confirm that he did not need a catheter or hospital admission”.
Publication reference: PR00164