Point of Care Testing (POCT): The Growing Role for Biomedical Scientists

Point of Care Testing (POCT): The Growing Role for Biomedical Scientists

Point of care testing has expanded dramatically across the NHS, moving laboratory-quality diagnostics directly to the patient's bedside, GP surgery, or community setting. For biomedical scientists, POCT represents a growing area of professional responsibility that combines technical expertise with governance, training, and quality management. Understanding this field opens up specialist career opportunities that are increasingly in demand.

What Is Point of Care Testing?

POCT refers to diagnostic testing performed near the patient, outside the traditional laboratory setting. Results are typically available within minutes, enabling rapid clinical decisions. Common POCT tests in the NHS include:

• Blood gas analysis (pH, pO2, pCO2, lactate, electrolytes)
• Blood glucose monitoring for diabetes management
• INR testing for patients on warfarin therapy
• Cardiac troponin for suspected myocardial infarction
• D-dimer for suspected venous thromboembolism
• HbA1c for long-term glucose control
• Urine dipstick analysis and pregnancy testing
• Rapid infectious disease tests including COVID-19, influenza, RSV, and streptococcal antigen

The BMS Role in POCT

Biomedical scientists bring unique value to POCT because of their understanding of analytical quality, pre-analytical variables, and result interpretation. The BMS role in POCT encompasses several key areas.

Governance and Oversight

Every POCT device used in an NHS trust should fall under the governance of a POCT committee, typically chaired by a consultant chemical pathologist or haematologist. Biomedical scientists, particularly POCT coordinators, provide the technical expertise that underpins this governance structure.

This includes establishing policies for device selection, operator training, quality control, and result management.

Training Ward Staff

Nurses, healthcare assistants, and other clinical staff who operate POCT devices need structured training to ensure competent use. Biomedical scientists design and deliver this training, covering:

• Correct sample collection and handling
• Device operation and calibration
• Quality control procedures
• Recognising and acting on abnormal results
• Documentation and result recording

Quality Management

POCT devices require the same quality assurance rigour as laboratory analysers. The BMS role includes:

• Internal quality control (IQC): Ensuring control materials are run at appropriate intervals and results are within acceptable limits
• External quality assessment (EQA): Enrolling devices in UK NEQAS or equivalent schemes and acting on performance reports
• Device maintenance: Scheduling and documenting calibration, maintenance, and troubleshooting
• Incident management: Investigating and reporting POCT-related incidents

Device Selection and Procurement

When new POCT devices are being evaluated, biomedical scientists contribute to the assessment process. This involves analytical validation, comparison with laboratory methods, workflow analysis, and connectivity assessment.

ISO 22870 and Quality Standards

ISO 22870:2016 is the international standard specifically for POCT quality and competence. It works alongside ISO 15189 and sets requirements for:

• Organisational structure and management of POCT
• Training and competence assessment of operators
• Quality control and external quality assessment
• Pre-examination, examination, and post-examination processes
• Equipment management and information systems

The POCT Coordinator Role

Many trusts employ a dedicated POCT coordinator, typically graded at Band 6 or Band 7 (£37,338-£52,809). This role is often based within the biochemistry or haematology department but works across the entire trust.

Typical Responsibilities

• Managing all POCT devices across the organisation
• Chairing or supporting the POCT committee
• Developing and maintaining POCT policies and standard operating procedures
• Delivering and recording operator training
• Managing POCT quality control and EQA participation
• Ensuring POCT connectivity to the trust's electronic patient record
• Leading POCT-related audits and accreditation activities
• Evaluating new devices and technologies

How POCT Is Expanding

POCT is no longer confined to hospital wards. The NHS is expanding near-patient testing into:

• Community Diagnostic Centres (CDCs): The NHS England programme to establish CDCs across the country includes POCT as a key component, bringing diagnostics closer to patients
• GP surgeries: HbA1c, CRP, and INR testing in primary care reduces the need for laboratory referrals
• Pharmacies: Some community pharmacies now offer POCT services
• Ambulance services: Pre-hospital troponin and blood gas testing is being piloted in several regions
• Patient self-testing: Devices for INR self-monitoring and continuous glucose monitoring are becoming more common

IBMS Guidance and Resources

The IBMS has published guidance on the role of biomedical scientists in POCT, recognising it as a legitimate and growing area of professional practice. POCT-related CPD activities are valued by the IBMS, and experience in POCT governance strengthens applications for specialist and management roles.

Challenges in POCT

Despite its benefits, POCT presents several challenges:

• Connectivity: Ensuring all POCT results are transmitted to the electronic patient record automatically, rather than relying on manual transcription, remains a significant issue in many trusts
• Operator competence: Maintaining training and competency records for hundreds or thousands of POCT operators across a trust is a substantial administrative burden
• Result quality: POCT devices generally have wider analytical imprecision than laboratory analysers, and understanding these limitations is important for clinical safety
• Cost management: POCT consumables can be expensive, and controlling usage requires effective governance

Key Points

• POCT brings diagnostic testing to the patient's bedside, with common tests including blood gases, glucose, INR, and troponin
• Biomedical scientists provide governance, training, quality management, and device selection expertise for POCT
• The POCT coordinator role (Band 6-7) is a dedicated specialist position found in most NHS trusts
• ISO 22870 is the quality standard for POCT, working alongside ISO 15189
• POCT is expanding into community diagnostic centres, GP surgeries, pharmacies, and ambulance services
• EQA participation through UK NEQAS is essential for POCT quality assurance
• Connectivity and operator competence are the most significant ongoing challenges
• POCT experience strengthens career progression and is valued in specialist and management applications