How point of care testing in the home is transforming healthcare

My name is Ken Kohut. I am the Mobile Integrated Health Program Specialist for the community paramedicine program within Niagara Emergency Medical Services. The role of our program is to support clients outside of 911 to better support the high users of the 911 system and the regional emergency departments.

This includes client advocacy, in-house assessments and point of care. It's my feeling that point of care offers the ability to combine quantitative results with qualitative observations in real time. This has value in that it's informative to the patient that is well-versed in their health knowledge, and it alleviates fear brought on by the present situation.

Point of care also gives data that medical oversight can understand and act upon, which helps to decrease liability. In the realm of community paramedicine, the majority of patients remain at home, which brings a level of liability with it. In addition to the comprehensive assessment, the caregiver can use the results of point of care to make sound treatment decisions to decrease ER visits and 911 activation, or support the decision to expedite these services.

Point of care lays a solid foundation in the decision to implement appropriate care. The challenges of past practices regarding pre-hospital assessment in the patient's environment involve making clinical observations and critical decisions while not being able to support these observations with quantitative testing.

This is improved with the implementation of 12-lead ECG, Sp02, end-tidal CO2, and glucometry, but it hasn't included point of care bloodwork, for example. Point of care helps to determine etiology and it quantifies severity of condition, whether it be electrolyte disturbances, kidney function abnormalities, dehydration, anemia, acidosis, et cetera.

In a routine setting, point of care bloodwork is performed at no expense to the client, which lessens the economic burden, and for the marginalized patient, finances are a large social determinant of health barrier. So, in-house bloodwork can carry a substantial cost for fee for service agencies that attend the home.

So, point of care provides financial savings to the patient. Isolation initially necessitated the use of point of care because it provided immediate results at the patient's place of care.

Point of care work produces a basic metabolic panel in 110 seconds, which speeds up the diagnostic process. This is critical in the emergency setting, and the high sensitivity results alleviates unnecessary ER visits, or allows immediate attention and expedites care. I see a large window of opportunity for point of care in the future, and it's my hope that future bedside, or chairside bioassays will evolve and be instrumental in saving lives, or ruling out pathology, which will be cost-effective in the healthcare industry.