Point of Care Laboratory Testing and its Effect on Confidence in Clinical Decision Making

Abstract

Background

Performing and interpreting point of care laboratory testing is an advanced skill that requires additional training outside of a critical care transport providers primary education. Providers must be knowledgeable and confident in their ability to perform all clinical tasks to exude competence. Limited evaluations of self-efficacy and perceived confidence exist in the CCT, point-of-care testing realm.

Objective

This study aims to evaluate perceived confidence in clinical decision making of providers utilizing point-of-care testing (POCT) in the CCT setting.

Methods

A cross-sectional survey was administered to providers of a CLIA licensed critical care transport team. The survey was of electronic format, queried demographics and subjective concepts using a psychometric response scale. The survey was anonymous and voluntary. Both critical care nurses/paramedics of this CLIA licensed agency, who operate under an EM, FAEMS medical director, who is the certified laboratory director, were eligible to participate in the survey. Providers not employed at the agency prior to receiving CLIA licensure were excluded.

Results

Survey participants included critical care nurses (70%) and critical care paramedics (30%), all whom (n=10) self-identified as board certified through BCEN or IBSC. Experience in critical care transport varied finding 0-3 years (40%), 4-7 years (30%), and 10+ years (30%). All survey participants agreed or strongly agreed with concepts regarding POCT and its positive effect on patient safety and quality of care with recent laboratory results. Likewise, all participants agreed or strongly agreed their clinical acumen increased as did their confidence interpreting laboratory results because of required quarterly education. Participants found the availability of POCT increased their confidence in clinical decision making as well as made clinical decision making easier. 30% of providers attested to questioning the appropriateness of the care they provided prior to having POCT availability with 50% answering neutral and 20% disagreeing to that statement.

Conclusion

This survey highlights the positive impact of POCT on CCT providers confidence in clinical decision making. The results demonstrate that POCT enhances clinical acumen and fosters greater confidence among providers when interpreting laboratory results, while improving patient safety and care quality. The findings suggest that ongoing education and access to POCT contributes to the providers sense of subjective competence, making clinical decisions more streamlined. However, a portion of providers expressed uncertainty in the appropriateness of care before the availability of POCT, indicating areas for further investigation into the impact of POCT on patient safety and clinical outcomes. This survey underscores the importance of continued training and support in the CCT setting to optimize the use of POCT and improve patient outcomes and safety. As POCT continues to grow in CCT, further research should explore the effects of POCT on clinical outcomes and provider behavior.