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Near Patient Testing

Healthcare workers in primary care have historically been unable or unwilling to undertake laboratory investigations because of their complexity and high cost. The procedures have often required specialist skills, training and knowledge which has kept them firmly based in the laboratory.

New technological developments have seen the idea of near patient (or point-of-care) testing being recycled, and a number of professional bodies have been examining the practice, legal status and ethics of NPT by non-specialist staff. This becomes even more important with the rôles of many NHS professions changing in relation to implementation of Patient Focussed Care, which may mean boundaries of involvement being modified.

Why should NPT be attractive anyway?

There are several reasons:-
  1. Convenience to the patient - earlier information can speed diagnosis or treatment.
  2. Convenience to the doctor - earlier diagnosis or treatment resulting in the need for fewer consultations.
  3. Ease of review - monitoring response to therapy is much easier if results are available during a consultation rather than hours or days later.
  4. When one parameter is needed, rather than a battery of tests.
  5. Cost - the cost of a simple NPT analysis may be cheaper while retaining the same level of reliability as larger laboratory systems.

Criteria for any useful NPT system

  • Results should be accurate and precise - results should be reliable. It is probably naïve to imagine that a (relatively) low cost NPT system will give the same level of precision as a high cost laboratory unit and it may well be that "acceptable" levels of performance need to be defined for defined clinical purposes rather than expecting state of the art perfection.
  • Users should participate in External Quality assurance schemes (see Bandolier #9 ; Being in Control ).
  • Equipment and reagents should be well supported by the manufacturer with regard to training, documentation, customer support and maintenance.
  • Equipment and technology should be robust.
  • Safety should be paramount, with any hazards being clearly identified. Mechanical/electrical, chemical (reagents) and biohazards should all be identified.
  • The tests should provide meaningful clinical information.
  • It should be simple to run and maintain, and be cost-effective.
NPT is presently viewed with justifiable scepticism. The perception is that NPT involves complex equipment which is difficult to use and expensive, and studies tend to support this (see Bandolier #3 ; Near Patient Testing ).

Literature searches have not revealed many systematic appraisals of NPT, although several have examined the use of smaller items of laboratory equipment in general practice. This reflects the fact that genuine NPT methods which make sense, especially sense for GPs, have not yet been introduced, and the real comparison so far have more to do with siting of laboratory equipment. Some useful literature includes:-
  1. I Smith. Revolution in varying degrees. Institute of Medical laboratory Sciences 1993; 277-80.
  2. NCH Scott. Desktop laboratory testing in laboratory practice. British Medical Journal 1989; 299:579-80.
  3. Point of care testing (9 articles). Medical technology International 1994, Number 1 (ISSN 0256 00107).
Ian Ware
Anglesey



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