Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden

Abstract

ObjectivesIn many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs.DesignQualitative focus group discussions study. A data-driven content analysis approach was used for analysis.SettingThe PED of a secondary paediatric hospital in Stockholm, Sweden.ParticipantsTwenty-four healthcare providers clinically active at the PED were enrolled in six focus groups.ResultsA range of POCTs was routinely used. The emerging theme Utility of our POCT use is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation.ConclusionDespite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.

Point-of-care diagnostic technology in paediatric ambulatory care: a qualitative interview study of English clinicians and stakeholders

“…Child health nurses have highlighted in an interview study that parents felt empowered by being able to take care of their child in a safe and structured way at home 29. Our participants didn’t express the concern found in a Swedish study of hospital clinicians that POC testing at home may drive unnecessary testing 19…”

“… 29 Our participants didn’t express the concern found in a Swedish study of hospital clinicians that POC testing at home may drive unnecessary testing. 19 …”

“… 18 Rasti et al , in a qualitative survey of nurses and doctors in a Swedish children’s emergency department, found that while POC tests benefits included better satisfaction from families who wanted a test for their child and greater reassurance in some instances in clinical decision-making, those surveyed feared the use of POC tests in hospital and at home might drive more unnecessary testing and that reliance on POC tests could diminish clinical skills. 19 …”

“…Pandey et al , in a survey of UK children’s emergency departments and paediatric assessment units, found lack of funding, a lack of evidence and governance issues surrounding quality assurance of tests, meant several new biomarkers, which already exist, had not been adopted in the majority of units 18. Rasti et al , in a qualitative survey of nurses and doctors in a Swedish children’s emergency department, found that while POC tests benefits included better satisfaction from families who wanted a test for their child and greater reassurance in some instances in clinical decision-making, those surveyed feared the use of POC tests in hospital and at home might drive more unnecessary testing and that reliance on POC tests could diminish clinical skills 19…”

Shortages of Care and Medical Devices Affecting the Pediatric Patient Population

“…However, with appropriate training and implementation, POCTs may have a role in pediatric EDs to save time and resources in times of resource constraint. 25 In addition to their in-hospital use, POCTs can be used in settings such as pharmacies and even at home.…”