Venous blood point-of-care testing (POCT) for paramedics in urgent and emergency care: a single-site feasibility study (POCTPara).

Abstract

Introduction: Paramedics play an important role in addressing the growing demands in urgent and emergency care. Point-of-care testing (POCT) devices are increasingly portable and may assist with appropriate non-conveyance, but limited research exists to support this. This feasibility study aimed to inform the design of a larger study to determine whether it is practical for paramedics to use blood analysis POCT.

Methods: An eight-month single-site feasibility sequential explanatory mixed-method study was conducted between April and December 2023, with a team of specialist paramedics who were provided with Abbott® i-STAT Alinity™ POCT devices with CHEM8+ and CG4+ cartridges. Using a qualitative evaluation of paramedic participants' experience with a POCT device and a descriptive analysis of case report forms and routine ambulance service data collection.

Results: Seven specialist paramedics were recruited; 287 patients were screened, of which 252 (88%) were excluded and 35 (12%) were recruited. Lack of mental capacity excluded 76% of cases. The mean age was 82 years; 40% of participants were female and 60% were male. Hospital conveyance rates were four (11%) of the recruited patients. In those recruited and not conveyed, the median time on scene was 120 minutes. The success rate to obtain a test result at the first attempt was 81% (CHEM8+) and 84% (CG4+). Test result failure rates were 13% (CHEM8+) and 3% (CG4+). Focus group data revealed that paramedic participants considered POCT useful for decision making and the device procedures to be acceptable. Paramedics reported that extended time on scene was related to trial procedures and waiting times to discuss test results with healthcare professionals.

Conclusion: The POCT devices were acceptable and practical for use by our specialist paramedic participants. The results of this feasibility study should inform the design of a larger study to test the impact of using POCT, to understand challenges in recruitment and retention where POCT is utilised and to determine the clinical presentations where POCT can be applied.