Benefits, barriers and facilitators for out-of-hospital point of care testing: a qualitative study

Heightened pressures on hospitals and Emergency Medical Services (EMS) due to growing demand and staff shortages have led to prolonged ambulance response times and delays in handing over the care of EMS patients on arrival at an Emergency Department. These delays jeopardise patient safety and staff wellbeing. Point of care (POC) tests in EMS have been proposed to facilitate effective on-scene decision-making, reduced conveyance, improved clinical outcomes, enhanced system efficiency and patient experience. Despite an acceleration in POC testing during the Covid-19 pandemic, limited evidence exists for integrating POC tests into routine EMS practice. The aim of this research was to explore the impact, benefits, barriers, and facilitators of POC testing in United Kingdom (UK) EMS, alongside factors influencing future research on POC testing implementation.

Convenience and snowballing sample techniques were used to recruit a diverse stakeholder group, including patient and public participants, for online semi-structured interviews between June and July 2023. Interviews were recorded, transcribed verbatim and thematically analysed using the framework method. The codes were pre-selected using the outcomes of a prior stakeholder event and double coded by the research team.

A total of 25 participants took part in semi-structured interviews. Whilst most participants identified clear potential benefits associated with the implementation of further POC tests within UK EMS, barriers that need to be considered in future research were also highlighted. Three themes were identified: enhancing patient care and system efficiency through POC testing; navigating implementation challenges: balancing barriers and facilitators for successful implementation; building the foundations: key considerations for future research.

Our study indicates that although the adoption of further POC testing was viewed positively, with substantial potential for impact, it will be essential to carefully address the barriers identified, along with insights from prior research, to overcome the associated challenges effectively.