Speeding up respiratory diagnosis: clinical drivers, barriers, and system readiness for rapid molecular point-of-care testing in Saudi Arabia

Acute respiratory tract infections place substantial strain on healthcare systems, particularly during seasonal respiratory surges and mass-gathering events. Delayed confirmation of respiratory pathogens contributes to diagnostic uncertainty, unnecessary antimicrobial use, delayed infection prevention decisions, and inefficient patient flow. Rapid molecular point-of-care testing (mPOCT) offers near-PCR-level diagnostic accuracy with turnaround times compatible with real-time clinical decision-making; however, implementation and integration into routine clinical pathways remain variable across healthcare systems.

We conducted an implementation-focused mixed-methods descriptive study integrating a synthesis of published evidence with structured stakeholder engagement in Saudi Arabia. Primary data were collected through three multidisciplinary scientific meetings and a stakeholder survey (N = 35) involving physicians, point-of-care experts, and laboratory professionals from Ministry of Health (MOH), institutional, and private healthcare settings. Quantitative survey data were analyzed descriptively using R version 4.3.3, including exploratory descriptive subgroup summaries by workplace sector and stakeholder role. Qualitative findings from expert discussions were synthesized thematically and integrated with survey findings and published evidence through methodological triangulation.

Physicians represented 48.6% of respondents, with most participants working in MOH facilities (60.0%). Rapid mPOCT was reported to be routinely used during respiratory seasons, with 68.6% indicating daily use. Immediate treatment decision-making (74.3%) and patient management activities, including bed designation (57.1%), were the most frequently reported indications for testing. Nearly half of respondents preferred results within 15 min (45.7%), while most preferred turnaround times of 30 min or less (85.7%). Participants reported generally moderate-to-high implementation of rapid mPOCT (mean implementation score 7.69/10; range 2-10), although variability remained in guideline integration, standard operating procedures, and institutional implementation. Frequently reported implementation barriers included limited education or guidance (31.4%), perceived availability of alternative diagnostic approaches (28.6%), and financial or reimbursement constraints (28.6%).

Saudi healthcare stakeholders perceived rapid mPOCT as a valuable diagnostic tool for respiratory infections, particularly in emergency and acute care settings where timely results may support clinical decision-making. Wider implementation will require standardized diagnostic pathways, workforce education, supportive governance, and sustainable reimbursement strategies to facilitate consistent integration into routine clinical practice.