Valerie Pope, manager of pathology and laboratory medicine
Lauren MacDougall, senior public engagement and communications advisor
Technology can play a vital role in the delivery of patient care. The growing use of point-of-care testing (POCT) devices is one example, as they increase access to just-in-time patient test results.
POCT provides a range of testing procedures that are used in nearly every clinical area across the province. This innovative, fast-growing technology can significantly lower turnaround times and improve access to diagnostic information to support clinical care decisions.
POCT takes place close to the patient. It is often performed by non-laboratory health professionals such as registered nurses and licensed practical nurses, who are key partners in the successful integration of this technology.
Nova Scotia Health Authority (NSHA) and the IWK Health Centre (IWK) have collaborated to develop a standardized, provincial approach for implementing and monitoring POCT to ensure the delivery of person-centred, high-quality, safe and sustainable laboratory testing for Nova Scotians, especially in rural communities.
“Our small, rural emergency department makes use of point-of care-testing technology, said Dr. Karl Tennessen, who works at Twin Oaks memorial Hospital in Musquodoboit Harbour.
“Timely diagnostics such as troponin, liver enzymes and renal function are essential tools for emergency medicine. This technology empowers us to make important clinical decisions in-house without needing to transfer to a larger centre with its own dedicated laboratory. It increases the independence of the department and the safety of my practice.”
Although POCT is performed outside the clinical laboratory, it is subject to the same quality rigour as testing performed in the laboratory. The Pathology and Laboratory Medicine Program oversees the testing to ensure it meets accreditation standards and clinical service needs.
Through the use of POCT, Nova Scotia has decreased turnaround times for test results in emergency departments (EDs), collaborative emergency centres (CECs) and operating rooms (ORs). Once a sample is placed in a POCT device, the turnaround time ranges from one to 12 minutes, depending on the testing needed. This compares favourably with the time required to call back laboratory staff after regular hours to perform testing.
The clinical areas where adoption of POCT technology is most valuable include EDs, CECs, ORs, intensive care units and in mental health and addictions programs. POCT is especially effective in EDs and CECs in smaller rural facilities that are unable to sustain a full-service, onsite laboratory.
While the cost of POCT is greater than traditional laboratory testing, there are significant benefits when it is used appropriately for urgent and emergency testing to support clinical care.
At this time, Nova Scotia is one of the few provinces in Canada using POCT in EDs, having successfully introduced it in many EDs and CECs across the province.
Nova Scotia is well underway with the implementation of a software application (middleware) that will allow results to flow directly from the POCT devices to the laboratory information systems. Results will transfer automatically from there to the patient’s electronic medical record, clinical portals or health records, where they will be available with other lab results.
Increased automation will eliminate manual processes, lower the risk of errors and reduce clinical workloads. POCT devices used in EDs across the province have already been connected with the electronic medical record. The goal is to have all POCT devices connected to the electronic medical record by the end of 2018.
NSHA and the IWK are continuing to develop and enhance a standardized approach to POCT in Nova Scotia. The use of POCT devices leads to faster access to patient test results and more timely patient care decisions, which can support more positive patient outcomes.