Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objectives The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers’ views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.
Study design Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.
Setting Two university teaching hospitals in London and Newcastle.
Participants 24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).
Results There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.
Conclusion In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
Data availability statement
Data are available upon reasonable request. The datasets generated and/or analysed during the current study will be made available upon reasonable request through the London School of Hygiene and Tropical Medicine data depository (LSHTM Data COMPASS).
Study design Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.
Setting Two university teaching hospitals in London and Newcastle.
Participants 24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).
Results There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.
Conclusion In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
Data availability statement
Data are available upon reasonable request. The datasets generated and/or analysed during the current study will be made available upon reasonable request through the London School of Hygiene and Tropical Medicine data depository (LSHTM Data COMPASS).
Date Issued
2021-05-10
Date Acceptance
2021-03-30
Citation
BMJ Open, 2021, 11 (5)
ISSN
2044-6055
Publisher
BMJ Journals
Journal / Book Title
BMJ Open
Volume
11
Issue
5
Copyright Statement
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Sponsor
National Institute of Health and Medical Research
Grant Number
CL-2018-21-007
Subjects
diagnostic microbiology
infectious diseases
paediatric A&E and ambulatory care
paediatric infectious disease and immunisation
qualitative research
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Publication Status
Published
Article Number
ARTN e044510
Date Publish Online
2021-05-10