Building Sustainability in POCT Through Ward-Based Key Trainers – A Case Study from Theatres

Introduction

Point of Care Testing (POCT) services are rapidly expanding. New devices are being introduced at scale across acute, community, and even pre-hospital settings. The demand for bedside diagnostics is growing faster than ever, but POCT teams themselves are not expanding at the same pace. In most trusts, small central teams are now responsible for overseeing hundreds of devices and thousands of operators.

This challenge will only intensify. The NHS 10-Year Plan emphasises early diagnosis, rapid treatment, and care closer to home, all of which depend on the further growth of POCT. The demand for training, governance, and quality oversight will keep rising, but team resources are unlikely to grow in step.

The question, then, is how to deliver consistent, high-quality training and governance when clinical demand far outstrips staffing capacity.

The traditional training chain: Manufacturer → POCT Team → Ward operator is clear and auditable but quickly becomes unsustainable at scale. Introducing a ward-based Key Trainer model appears to be an obvious solution, but raises a governance question: would this be perceived as “third hand” training, something accreditation bodies scrutinise closely?

This case study describes how we piloted a Key Trainer approach at Manchester Royal Infirmary (MRI) theatres, the safeguards we implemented, and the significant benefits achieved, using the example of Jon, an Operating Department Practitioner (ODP).

Why ACT Testing Matters in Vascular Theatres

Activated Clotting Time (ACT) is an essential test in vascular surgery, providing clinicians with rapid feedback on the anticoagulant effect of unfractionated heparin. In MRI theatres, ACT is performed using the Abbott i-STAT Alinity POCT platform. It delivers results within minutes at the bedside, with connectivity and automatic data transfer into the electronic patient record, supporting fast decision-making.

To become a competent clinical operator of the Alinity, theatre staff are required to complete a structured learning programme comprising a training presentation and competency questions, followed by a face-to-face practical assessment delivered by the POCT team. Only once all components are successfully completed is operator access granted, and refresher training is required every 2 years.

The Challenge in Theatres

Anaesthetic and theatre staff faced a particular training barrier: their workload and shift patterns meant they struggled to attend centrally delivered POCT training sessions, as these can only be provided in office hours. Without a flexible training model, there was a real risk of staff being unable to use the Alinity when needed most.

The Candidate: Jon

Jon, an experienced ODP, not only volunteered for the Key Trainer role but was the first to raise the issue of training gaps. He highlighted how the lack of session availability was creating risk in theatres, where urgent access to POCT was critical. From the outset, he was proactive in seeking a solution.

The selection criteria for Key Trainers includes consistent device usage, strong QC performance, and no compliance issues. When we reviewed Jon’s statistics, he not only met these expectations but exceeded them, showing exemplary enthusiasm for education, meticulous record-keeping, and a genuine eagerness to learn from the POCT team.

As Jon explained: “As one of the most experienced operators, I volunteered to become a Key Trainer to expedite the rollout of the new device. My goal was to improve access to ACT testing, support colleagues, and champion better anticoagulation management during procedures.”

Implementation and Safeguards

To ensure ward-based trainers don’t become a weak link in governance, we built safeguards around the Key Trainer model:

Safeguard	How It Was Applied
Eligibility checks	Candidates must show consistent device use (patient tests, QC, acceptable EQA). No compliance issues allowed such as fictitious patient ID or barcode sharing.
Train the Trainer documentation	A comprehensive document standardised the process across devices. It covered clinical knowledge, QC, risk management, troubleshooting, and documentation. Included a self-certification to confirm readiness and professional responsibility.
POCT-led preparation	Prospective trainers attended POCT-led sessions, observing an experienced trainer. Crib sheets ensured training was consistent across all trainers.
Mock session observation	Trainers delivered a mock session observed by POCT staff, assessed for clarity, sequence, safe technique, result interpretation, and handling of questions.
POCT oversight	Annual audits of live training sessions plus review of activity stats. Trainers required to escalate any concerns to the POCT team.
Professional standards	Trainers signed a self-certification committing to maintain skills, uphold ethics, and escalate concerns. Managerial endorsement required to confirm suitability.

Outcomes

Jon’s impact as a Key Trainer was immediate and visible. Theatre staff could now receive training flexibly, at times that fitted their clinical duties, which had previously been a major barrier. This ensured that staff were no longer dependent on attending centrally delivered sessions during office hours, giving theatres greater autonomy and resilience.

Patient safety was also strengthened. There was always a trained member of the anaesthetic team available to operate the Alinity in emergencies, reducing the risk of delays in this setting. Equally important was Jon’s role as a communication link. He became a trusted bridge between the POCT team and theatre staff, helping to cascade updates, reinforce changes, and escalate issues quickly. Alongside this, his ability to troubleshoot device queries and resolve minor operator errors locally reduced unnecessary call-outs to the POCT team, freeing up central resources for more complex tasks.

Jon says: “Introducing a theatre-based Key Trainer has significantly improved staff confidence and expanded training coverage. More procedures are now monitored, troubleshooting happens in real time, and staff feel supported rather than hesitant to use the device.”

Because of Jon’s outstanding performance in the Key Trainer role for the Alinity, he has also been selected as an initial super user to support the rollout of a TEG6 service: a POCT device which guides the targeted use of blood products during high-risk surgery.

Lessons Learned

Not every staff member is suited to become a Key Trainer. Many volunteers approach the POCT team eager to take on the role, but when we review their activity statistics it often becomes clear that their device use is minimal. Once the full responsibilities are explained, including governance, iQC and EQA participation, annual audits, and observation of training sessions, some staff understandably reconsider. The most effective trainers are those who combine a genuine passion for education with strong hands-on experience. It is usually easy to spot who will excel in the role, and those individuals go on to make fantastic trainers.

Our full Train the Trainer framework is detailed and governance-heavy, developed with input from experienced POCT trainers. It represents our own gold standard, and all Key Trainers are required to complete it. However, not all POCT devices carry the same level of complexity or risk. In future, there may be scope to adopt a risk-based approach where the process of signing off a Key Trainer is proportionate to the device in question. For lower-risk platforms, the route to Key Trainer status could be streamlined while still maintaining appropriate oversight. Any move in this direction would need to be carefully managed to ensure governance is not compromised.

Looking ahead, we also recognise that appointing too many Key Trainers could itself become a risk. Each trainer requires observation, audit, and ongoing support from the POCT team, and there is a limit to how many can be managed effectively. Once one ward hears about the model, others are often keen to have their own, but it may not always be appropriate or necessary. Key Trainers should only be introduced where there is a clear gap or demand, not simply for the sake of it. Careful selection and a proportionate pace of expansion are essential to maintain governance and sustainability.

Conclusion

The trajectory is already set: the demand for POCT will continue to rise to meet the ambitions of the 10-Year Plan, yet this growth is expected at a time when NHS finances are under greater strain than ever. To meet this expansion sustainably, ward-based trainers will need to be utilised more widely as a pragmatic solution: the POCT team can be effectively extended by developing existing clinical staff into Key Trainers, rather than relying solely on expanding central resources.

Jon’s success as a Key Trainer proved that this model does work. He exemplified the qualities of an effective trainer: proactivity, passion, accuracy, communication, and commitment to quality. His work ensured devices were always available and competently used in critical procedures, improving safety for patients and sustainability for the POCT team.

Not everyone can or should be a Key Trainer, but when the right person steps forward, they are worth investing in. With safeguards in place, ward-based Key Trainers become true extensions of the POCT team, building capacity, resilience, and quality into the heart of clinical services. They also strengthen multidisciplinary teamwork by acting as a local link between laboratory, clinical, and educational staff, whilst helping ensure that POCT is not an isolated process but part of a joined-up system of care. This collaboration ultimately improves patient outcomes, as safe and timely testing becomes a shared responsibility. The key will be ensuring that their preparation is robust, their practice regularly audited, and that all activity remains aligned with UKAS standards, so that patient safety and governance stay at the centre of every innovation, even against the backdrop of today’s financial pressures.