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 their having greater laboratory accessibility. Although also part of the clinical routine in HICs, the utility of POCTs is relatively unknown in such settings as compared to others.In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterize health care providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to compare such experiences to those reported in other settings; and finally, to gather requests for ideal novel POCTs.DesignQualitative study using focus group discussions. A data-driven content analysis approach was used for analysis.SettingThe PED of a secondary paediatric hospital in Stockholm, Sweden.ParticipantsTwenty-four health care providers clinically active at the PED were enrolled in six focus groups.ResultsA range of POCTs was routinely used. The emerging theme Utility of POCTs is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local testing practice was named to distract from the care for patients. Requests were made for novel 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.ARTICLE SUMMARYStrengths and limitations of this studyThis is the first study to present the use and utility of POCTs in a HIC paediatric hospital setting, directly from the perspective of its clinical staff.Our main finding is that deficient implementation routines limit benefit of POCT services in this well-resourced setting, strongly indicating that such deficiencies are irrespective of resource level, and more related to policy deficiency.The findings of the relatively small study size may be contextual, yet we believe our main conclusions to be generalizable as most of our findings are compatible with those reported in other settings.The study is strengthened by the diversity of its participants, corresponding to the multi-professional staffing of the PED.