On International Pathology Day, a look at the post-pandemic expansion in near-patient testing
The expansion of near-patient testing after the COVID-19 pandemic was the focus of RCPI Faculty of Pathology’s event this year marking International Pathology Day.
The important college meeting in No 6 Kildare Street on 5 November began with a welcome by Prof Seán Hynes, the chair of the faculty’s Scientific Meetings Committee. “It’s about rapid turnaround time for our patients, and better outcomes overall,” said Prof Hynes.
Near-patient testing is a laboratory test performed by a health professional near the patient – often at patient’s bedside. Common examples are blood gas or glucose testing, urine pregnancy testing, COVID-19 or flu testing.
An overview of the national guidelines for near-patient testing – revised in 2022 by a consultative group and RCPI Faculty of Pathology – was given by Dr Gerard Boran (chemical pathologist, Tallaght University Hospital).
Dr Boran gave a presentation about a piloted programme at Tallaght University Hospital called “Lab in the Clinic” which is designed to bring the lab closer to the patient. The pilot programme has become an accredited service.
“There’s a need to remain rapid but also accurate. Tests need to be traceable in the event of a recall,” said Dr Boran.
Dr Boran warned of a “wild west” of diagnostics, due to a proliferation of direct-to-consumer testing kits available in supermarkets. (The difference between self-testing and near-patient testing is that the latter is administered by a health professional).
“We need more robust regulation for self-testing, more trustworthy public information, and pathways for interpretation and follow-up,” he said.
A surgeon’s perspective was given by Mr John Kinsella (ear, nose and throat surgeon, St. James’s Hospital and Tallaght University Hospital) who spoke about treating patients with hyperparathyroidism – a disorder in glands in the neck.
Treatment for hyperparathyroidism involves intraoperative parathyroid hormone (ioPTH) tests that are conducted during surgery – a near-patient test that, according to Mr Kinsella, avoids up to an hour in laboratory waiting time.
Mr Kinsella recommended the near-patient test as time-efficient but he also warned of pitfalls, including false positives making up 10% of results.
An audit of near-patient toxicology testing at Tallaght University Hospital was presented by Ms Phyllis Reilly (chief medical scientist).
Ms Reilly showed that introduction of a bedside device Quidel Triage Meter Pro was showing an improved diagnostic turnaround time of 50 minutes compared to a 200-minute waiting period for toxicology samples sent to the hospital’s clinical chemistry laboratory.
She said the surging demand for COVID-19 tests during the pandemic has made near-patient testing an extraordinary area of growth in pathology, with the near-patient diagnostics market projected to grow to $59bn by 2029.
Evidence of near-patient testing having a positive impact in Cork University Hospital’s emergency department was presented by Prof Patrick Stapleton (microbiologist). Prof Stapleton showed that near-patient testing by emergency department staff is accelerating detection of Respiratory Syncytial Virus, influenza and COVID-19.
According to Prof Stapleton, near-patient testing is often cutting diagnostic turnaround from hours to minutes, and is leading to faster discharges or admission decisions in cases where testing is conducted early in the patient’s emergency department journey.
While results show near-patient testing reducing diagnostic delays, Prof Stapleton warned that expansion in the area will lead to increased workload, imposing a significant burden on scientific and medical staff.
Lastly, Dr Joan Fitzgerald (haematologist) gave a presentation on the introduction of a rotational thromboelastometry (ROTEM) device used by midwifery and anaesthesia staff at the National Maternity Hospital.
The ROTEM device provides a real-time analysis of a patient’s blood-clotting ability, and helps guide treatment for obstetric haemorrhage.
Dr Fitzgerald said that feedback from staff using the ROTEM device found it beneficial overall but there remains an issue integrating the results into the hospital’s electronic patient record.
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