Point of Care Blog Series 1 – Blog 2. Bringing the Lab Home: How Community Teams Are Impacting Care in the Patient Home

Welcome to our readers.

We are joined today by Nicky Hollowood, POCT Cross Site lead IPS (Harrogate Airedale and Bradford) and Lead Healthcare Scientist

Moderator – Tony Cambridge

TC: Hi Nicky, it’s a pleasure to have you contribute to our blog series focussed on exploring hot topics in the point of care, rapid diagnostics and in-vitro diagnostics sector. You have significant experience in providing diagnostics in the community setting. Could you summarise this for our readers?

NH: I have been the POCT manager at Harrogate for 19 years and in this time as well as developing the acute services we have developed community based clinical services which use POCT as a diagnostic tool.  These range from electronically connected urinalysis analysers in GP surgeries, to a connected portable blood gas analyser used by our respiratory team to deliver the home oxygen service.  These services are accredited by UKAS against the latest ISO 15189:2022 standards

Excellent. Thank you for contributing your time so let’s get right to it…

How are community healthcare teams transforming patient access to care through the use of rapid diagnostic tools?

NH: Rapid diagnostic tools have developed significantly over the last few years; the technology is more sophisticated and there are more service functionality features built in.  Their performance, when used correctly, is in line with laboratory standard equipment which has led to an improved confidence from both laboratory and clinical staff in their use.  Clinical staff are becoming more informed about what equipment and tests are available and our POCT leads work closely with clinical teams to identify opportunities to improve patient pathways and access to services using this technology.  The diagnostics are often able to facilitate a complete restructure of the patient decision/management pathway, enabling us to move care away from the traditional acute care delivery point to community locations.

What benefits have patients experienced from receiving diagnostic results at the point of care in community settings?

NH: The main advantage is not having to attend an acute trust or hospital setting for a routine appointment and also preventing emergency admissions.  Our home oxygen service has enabled specialist respiratory nurses to visit the patient in their home, carry out a home review of their medications and environment as well as a blood gas and pulse oximeter test.  This is a whole patient review approach which enables the nurse to readjust the medication in line with the patient’s lifestyle needs and requirements.  Prior to this restructure of the pathway patients were required to attend the hospital for their appointment and due to their oxygen use, needed ambulance transfer. 

At the hospital site they often had to wait around for a significant period and were more at risk of contracting hospital acquired infections.  Following the appointment they then had to wait for transport home.  The appointment time in total for the patient often extended to half a day.

How are community teams collaborating with laboratories and hospitals to ensure continuity of care and data sharing?

NH: The devices which are available are often cutting-edge technology and have a lot of service functionalities built into them.  The laboratory and the POCT teams are able to work with the clinical teams to develop the service pathway to utilise these features and build them into the care pathway. 

Barcode scanners ensure that the data entered is accurate and not subject to transcription errors and user lock out ensure only trained users can access the device.  Quality control lockout enables compliance with quality procedures and upholds the quality of the patient results.  Many of these devices have the technology available to enable them to be electronically connected to a data management system and into the electronic patient record (EPR).  Connecting the devices enables the results to be shred across wider clinical teams and robust data analysis to be performed as needed.

The POCT teams will collaborate with the clinical teams to ensure that the device is used clinically in a way that adds value and supports the effective delivery of the clinical service, where the core laboratory is not able to.

What training and support do community healthcare workers need to effectively deploy rapid diagnostics?

NH: It’s important that we consider how the device can add value to the clinical service provision.  Having a robust clinical decision pathway is the key starting point to any POCT service development, it outlines when the test needs to be performed and the actions that need to be taken with the results.  Without this pathway the benefits of the point of care test are often not realised.  It is important that a multidisciplinary approach to developing the pathway is taken so we can each understand the current challenges and formulate a service which works well for the patient. 

During these early adopter discussions training and competency is often debated, we explore who will be trained to do the test and how they will receive training.  Depending on the service and test we may consider the value of developing a robust e-learning programme, training up cascade trainers or deliver group training sessions.  The training sessions often incorporate information about sample collection and preparation, processing the sample, data input and patient identification and results reporting.  Further information about quality control and EQA, troubleshooting and maintenance is also incorporated.  We back this up with information on our intranet site, laminated working instructions, competency training session and information about how to contact the team. 

How do rapid diagnostic tools improve early detection and management of infectious diseases in the community? How has the management of chronic disease improved?

NH: One of the biggest challenges in infectious disease management is making immediate decisions without any diagnostics or laboratory results.  Clinical symptoms aligned to infectious diseases such as flu, covid and RSV can be generalised, making a diagnosis from these symptoms alone challenging.  Having a rapid diagnostics result during this early decision making pathway supports the clinician with their decision making enabling the patient to be managed and treated more effectively.  This safeguards patients, their families and staff and reduces the risk of onwards spread if precautions are employed.  Screening for and diagnosing infectious diseases such as covid and flu will help with AMR management supporting the appropriate prescribing and use of antibiotics. 

Good management of chronic diseases such as diabetes often rely on the patient feeling empowered and educated to understand their own medical condition.  Management of diabetes has gradually started to shift more into primary care as glucose, ketone and HbA1c tests have become available on portable devices.  Specialist nursing teams are in community locations and support patients in managing their own condition at home where possible.  The development of the devices has now moved towards the use of wearables further empowering the patient to track their glucose levels and manage their own treatment and condition.

What challenges do community teams face in implementing and maintaining quality control for rapid diagnostics?

NH: The concept of internal quality control can be a new area for community teams to navigate as the medical devices that they are used to working with often don’t make use of quality control as part of the quality governance.  Understanding what quality control material is suitable can be challenging to a non-laboratory professional as some material requires reconstitution or refrigeration.  It is also difficult to ascertain a suitable frequency of testing and when corrective action might need to be taken. Interpreting the results and understanding the reasons for poor compliance is something that is part of the laboratory professional training but can be a new area for clinical staff to understand. 

Enrolment in an external quality assurance (EQA) scheme, returning and interpreting results can also be a challenge.  These are the areas that laboratory professionals can add significant value to the POCT service, this can be made easier and more practical if the devices are electronically connected as this monitoring and assessment can be performed remotely and the data is not subject to transcription errors and incomplete reporting.

How does the use of rapid diagnostics in the community help reduce unnecessary hospital attendances and admissions? Who else is involved in demonstrating the benefits?

NH: Making diagnostics accessible before the patient might require hospital admission supports clinicians in making interventions earlier in the patient management pathway, moving the pathway more into preventative care.  Effective monitoring of chronic conditions and ensuring that treatment plans are optimised is key in preventing medical emergencies such as hyperglycaemia and diabetic ketoacidosis (DKA) which if not managed correctly can rapidly lead to a hospital admission and a poorer outcome for the patient. 

Patients who are on warfarin can monitor their INR using their own meter or attend a community based clinical assessment removing the need to travel to a hospital.  Rapid diagnostics are a powerful tool that can able us to shift pathways from managing sick patients to prevent the illness and disease taking hold.

What role do digital tools play in supporting rapid diagnostics and real-time reporting in community care? Are we there yet?

NH: I am a keen advocator for digital management and connectivity of POCT devices as fundamentally it ensures robust quality governance of POCT services.  Generating accurate results from unconnected devices is reliant on healthcare professionals not making errors.  Whilst no process is completely error free, a connected device often has more sophisticated functionality; untrained users can be locked out, ensures data is inputted via a scanner, ensures compliance with quality control procedures, etc.  These features help to minimise human error and reduce the risks associated with using these devices, safeguarding the patients and healthcare professional. 

Real time reporting which is enables through connectivity ensures that the data generated by these devices can be shared between healthcare professionals facilitating multidiscipline management and robust record keeping.  Are we there yet?  We are never there! As soon as we think we have achieved what we are aiming for the commercial sector bring newer technology to market capable of going further.  As healthcare is a dynamic evolving service we are constantly seeking new opportunities to go further and do better using technology as a tool to help us deliver these.

How are funding and policy decisions influencing the rollout of rapid diagnostic tools in community healthcare? What variation is present across the healthcare landscape?

NH: The POCT service provision in NHS organisations is currently highly variable, I have seen some real cutting-edge services which have full end to end connectivity for many of their services enabling some fantastic patient centred clinical services to be set up.  However, that isn’t the case everywhere, the huge limiting factor is often financial, lack of (experienced) staff employed in POCT services, high cost of equipment and software and limited clinical input into decision pathways.  It is hoped that central policy and guidance will enable a standardised approach to be adopted, good practice shared and for the services to be appropriately funded going forward.

The NHS 10-year health plan for England aims to transform the NHS by focusing on community based care, digital transformation and preventative health measures.  Rapid diagnostics can be a powerful tool supporting the development and delivery of these new services if we harness and utilise them appropriately.  The Life Sciences Sector plan (July 2025) will enable the commercial and research sector to develop and deliver new technology needed at speed.  

The commercial sector is keen to promote the role of their Medtech in supporting the delivery of the national plan, but it is critical that they engage with the appropriate laboratory and scientific professionals to ensure they are embedded within a robust, high quality service structure and that we are able to realise the promoted performance and accuracy in routine practice.

What are the next steps needed to further expand the role of community teams in delivering diagnostics-led patient care? Where can the evidence be found to support this roll out?

NH: It is important that our healthcare professionals become more experienced in using these devices and appreciating their limitations.  POCT is starting to embed within the professional training for many healthcare professionals, so they are seeking out opportunities themselves outside of contacting the laboratory.  They are often presented with new Medtech devices at their professional meetings and conferences and are keen to use them to develop their services.  This can be very powerful as the clinician is leading the change, but it is also critical that they engage with the laboratory to ensure that the technical component of the service is developed to a high quality and is good value.  Without this the service will fall short of expectations and will lead to clinical and patient frustration. 

We may see the hospital-based specialist teams moving more to the community setting and we may see the role of the community teams developing to enable the delivery of the 10 year health plan.  Either way it is important that POCT teams and scientific staff develop and sustain a strong relationship with our clinical colleagues and work to support them through these changes. 

TC: This is a very thought-provoking topic especially in view of the release of the 10-year plan and an expected shift towards out of hospital care. Your experience and shared learning will be very valuable to the readers.

Thank you to Nicky Hollowood for sharing her expertise and participation in this blog series. Follow Nicky on LinkedIn.

Point of Care Blog series 1 : Blog 3 coming soon…

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