Point-of-care testing in the spotlight

Point-of-care testing (POCT) offers the potential to speed up clinical decisionmaking, as well as improve outcomes and patient management, by providing rapid access to results at the bedside. However, implementing POCT in the clinical setting also presents challenges and raises important issues to be addressed – some of these are the subject of discussion at the Biomedical Science Congress. Hosted by the Institute of Biomedical Science (IBMS), the Congress programme provides three full days of active learning in science, education, training, management and leadership. This year, a series of seminars looks specifically at diagnostic tests and techniques involving direct contact with patients and, increasingly, their direct participation. The seminars are supported by a dedicated feature in Hall 4 – as well as the POCT displays in the free to attend exhibition. The seminars are designed to be of direct relevance to anyone involved in the provision of a POCT service. The smaller, more informal nature of these sessions enables delegates to discuss and debate the issues with the presenters and to exchange their ideas and experiences. The seminars cover a range of approaches, with presenters sharing insights into how they have approached the challenges they have faced in delivering their respective POCT services. Many of the seminars have broad appeal to clinical staff within the acute sector, as well as healthcare professionals responsible for care delivery in the community setting. There are also presentations focusing on key aspects of infection prevention and control, which will prove invaluable for all those on the front line of care delivery.

Programme highlights

Among the sessions focused on POCT at the Congress, include a presentation by Mr Colin Walker, Portsmouth Hospitals NHS Trust, entitled: Microbiology tests at the bedside: a growing reality? POCT, also known as bedside or near patient testing, has been defined as “an analytical test undertaken by a member of the healthcare team or by a non-medical individual in a setting distinct from a normal hospital laboratory”. POCT is well established for blood sciences where a range of bedside tests have been available for a number of years. Colin Walker argues that point-of-care tests for diagnosis of microbiological infections have been slow to develop as they require the detection of specific bacterial or viral antigens or antibodies. Diagnosis of microbial infection has traditionally relied on culture techniques, antibody detection using serological methods and direct detection of molecular targets – all of which have required specialist culture media, enzyme immunoassay or nucleic acid technologies respectively. The exceptions have included the use of ‘chemical dipsticks’ for the diagnosis of urinary tract infections and rapid antigen tests for the diagnosis of streptococcal pharyngitis. However, over the past ten years, there has been an increase in the number of ‘rapid’ tests being used for diagnosis of infections within clinical microbiology laboratories – in particular, respiratory and sexual health infections. These tests include those which have been specifically designed for use at point of care. The tests are based on detection of specific antigen or antibody using three principle methods: immunochromato-graphic, enzyme immunoassay or molecular methods. In view of pressures on healthcare institutions for more effective patient management, which is increasingly reliant on pathological diagnosis, Colin Walker considers the question: ‘Should clinical microbiology laboratories embrace the new point-of-care tests and work with users to introduce these techniques?’ It may be all too easy to retain these tests within the ‘domain’ of the laboratory, but there is the concern that ‘users’ will bypass the laboratory and use the tests within their own clinical areas giving rise to fears regarding regulation, training, competence and quality assessment. Colin Walker further argues that the range, performance and ease of use of microbiological point-of-care tests are only going to increase and healthcare users will realise the benefits. He also emphasises the need for clinical microbiology laboratories and clinical staff to work together to ensure appropriate introduction, to benefit the user, laboratory and especially the patient.