Driving improvement, delivering results: healthcare science national delivery plan 2015–2020

2 Improvement programme in point-of-care testing

Why this matters

Point-of-care testing (POCT), also known as near-patient testing, is used in primary care and acute units to facilitate local decision-making, improve patient safety and outcomes, and impact positively on patient flow. Good-quality POCT in primary care environments can improve patient experiences and avoid the need for secondary care referral. In secondary care, it facilitates clinical decision-making: in relation to effective management of norovirus outbreaks, for example, good-quality POCT reduces diagnosis times from 24 hours to 90 minutes, resulting in a 50% increase in bed availability and a reduction in ward closures, all of which supports earlier discharge of patients.

POCT carried out by staff who have not been adequately trained or are using inappropriately calibrated or non-functioning equipment can, however, lead to false results. Consequently, significant numbers of patients may be unnecessarily referred to secondary care for more complex and perhaps invasive investigations, causing avoidable distress and the potential for patient harm.

Where POCT in-vitro diagnostic (IVD) testing is provided, it is essential that it is appropriately quality-controlled. The MHRA guidance (2013) and the International Standard for POCT (ISO 22870:2006) specify healthcare science staff involvement in the selection and quality-assurance of POCT devices and training.

The Royal College of Pathologists (2004), the MHRA (2013), Clinical Pathology Accreditation (2010) and the Institute of Biomedical Science (2004) have issued guidance on the management and governance of POCT services, and specific guidance for Scotland was produced by the Scottish Medical and Scientific Advisory Committee in 2011 (Scottish Government, 2011).

A recent audit commissioned by the Diagnostic Steering Group (unpublished) reported 1031 individual POCT services across 10 NHS boards providing 35 POCT tests, with an estimated annual workload of around 650 000 tests. Sixty-one per cent of the POCT services were situated in primary care locations and 39% in secondary settings. Recommendations were made in relation to improvements in clinical governance, the requirement to establish POCT committees, improved IT connectivity and better utilisation of healthcare science expertise. These recommendations are consistent with the ambitions of this improvement programme, which will accelerate actions from the audit.

The healthcare science workforce has the skills and expertise to improve POCT service delivery in the community by supporting quality assurance of investigations and the safe and effective use of equipment. Healthcare scientists need to share this expertise with wider primary care and community settings, providing guidance on procurement, maintenance, repairs and training to enhance the competencies of non-healthcare science staff using equipment and carrying out investigations in the community.

Current situation

Roll-out and clinical governance of POCT (specifically in relation to quality control, application of MHRA guidance and overall healthcare science involvement) varies across NHS boards. This has significant implications for patient safety and patient flow.

Our ambitions

We want to:

• reduce unnecessary variation within and across NHS boards
• improve patient experience by reducing unnecessary secondary referrals
• reduce repeat testing and associated costs
• improve patient flow, access and monitoring.

Deliverable 2

To achieve our ambitions, NHS board healthcare science leads will work with medical directors and clinical teams to develop a local implementation plan that ensures clinical governance and effective roll-out of point-of-care testing. This will be achieved by the end of 2017 in acute services and the end of 2018 in primary care, with full implementation by the end of 2020.

Achieving Deliverable 2

NHS boards will:

• participate in the national POCT programme on the use of POCT in primary and secondary care in Scotland (as described by the Scottish Medical and Scientific Advisory Committee (Scottish Government, 2011)), implementing local plans to ensure cost-effective implementation and governance of POCT systems and sharing knowledge across boards on how POCT technology benefits patient-pathway outcomes.

National healthcare science leads and NHS board healthcare science leads, managers and heads of services will:

• work across disciplines to instigate whole-system improvements in the delivery of POCT in acute and secondary care settings.