User Perspectives of Cardiac Marker Point-of-Care Testing for Hospital-Based Chest Pain Diagnosis

Abstract

An assessment of the value and impact of cardiac markerpoint-of-care testing (POCT) in chest pain diagnosis within the Northern Ireland acute health care system was carried out via a structured survey. The study presents the views and opinions of health care professionals on key aspects of cardiac marker POCT usage at 10 major hospitals. The overall use of POCT for the identification and quantification of relevant markers associated with myocardial infraction has been established. Of the 100 responses received, 28 were from actual users of cardiac marker POCT, whereas the remainder were from other specialists in related fields but with direct relevant knowledge of the diagnostic platforms concerned. Hence, the information reported offers an opportunity to directly compare different user perspectives in the context of the early stages of uptake of POCT for frontline clinical assessment. The main POCT user group respondents were clinicians/nurses and clinical scientists, with nursing staff being the largest cohort overall. Troponin I was the most reported (75%) cardiac marker measured and the Dade Behring STRATus CS device (Marburg, Germany) the most commonly used test platform. Test turnaround times with POCT were perceived to be between 15 and 30 minutes as compared with Central Laboratory testing of 60 to 90 minutes' duration. With the exception of the clinical scientists, the perception of data from cardiac marker POCT was considered to be of an equivalent quality and accuracy to that obtained from Central Laboratory testing. Interestingly, clinical scientists also indicated their belief that implementation of a POCT-based service would alter their relationships to clinical and nursing staff and to patients. The general opinion of all the health care professionals surveyed was that POCT implementation and accreditation should be overseen and regulated by Central Laboratory specialists to ensure the validation of results. This suggests that POCT may create new roles for clinical scientists outside the Central Laboratory at the hospital department/ward level.