Abstract

Background: Traditional laboratory diagnostics introduce delays in clinical decision-making. Near-patient pathology testing, also known as point-of-care testing (POCT), delivers results at or close to the bedside, reducing turnaround times and supporting faster interventions.

Objective: To review the clinical rationale, current applications, technologies, and market landscape of POCT, with particular reference to the United Kingdom, while considering challenges and future directions.

Methods: A narrative review was undertaken using peer-reviewed publications (2008–2023) and authoritative guidelines (WHO, NHS), supplemented by company information on UK POCT suppliers. Sources were identified via PubMed, Google Scholar, and professional society websites, with priority given to systematic reviews, clinical trials, and guideline documents.

Findings: POCT enables rapid decision-making in intensive care, theatres, emergency departments, neonatal units, and outpatient settings. Key applications include blood gas analysis, cardiac marker testing, glucose monitoring, and infectious disease immunoassays. Benefits include improved outcomes, enhanced patient flow, and reduced pre-analytical errors. Challenges remain around cost, operator training, quality assurance, and system integration. The UK market is served by multinational companies (Roche, Abbott, Radiometer) and domestic manufacturers (EKF Diagnostics, Woodley Equipment Company).

Conclusion: POCT is reshaping acute and chronic care pathways by bringing diagnostics to the patient’s side. Future developments will centre on artificial intelligence-supported interpretation, digital connectivity with NHS systems, and expansion into community and home care.

Keywords: Point-of-care testing; near-patient testing; pathology; diagnostics; NHS; acute care.

Introduction

Pathology testing is a cornerstone of clinical medicine, underpinning diagnosis, treatment decisions, and monitoring of outcomes. The conventional model of sample transport to a central laboratory can delay clinical decisions, particularly in acute settings. Point-of-care testing (POCT), also termed near-patient testing, offers results within minutes at or near the bedside.

In the UK, growing demand for rapid diagnostics in acute hospitals and primary care has driven uptake of POCT. This review examines the clinical rationale, range of applications, available technologies, UK supplier landscape, and future directions.

Methods

This narrative review synthesises evidence from peer-reviewed journals, guideline documents, and authoritative organisational reports. Searches were conducted in PubMed and Google Scholar using terms including “point-of-care testing,” “near-patient pathology,” “UK,” “blood gas analyser,” and “cardiac markers.” Sources between 2008 and 2023 were considered. Reference lists of key articles were screened for additional material. Company information was retrieved from official websites (accessed August 2025) to provide current market context.

Findings

Clinical Rationale

The primary advantage of POCT is speed. In intensive care, blood gas analysis can inform ventilator settings within five minutes, compared with laboratory turnaround times exceeding 30 minutes [1,2]. In emergency departments, rapid troponin assays enable earlier diagnosis of myocardial infarction and initiation of therapy [3]. For chronic disease, immediate HbA1c results allow medication adjustment in a single visit [6].

Key benefits include:
- Faster diagnosis and treatment [1,2]
- Improved outcomes in acute conditions [3,4]
- Enhanced patient flow and efficiency [5,6]
- Reduction in pre-analytical errors [2]

Limitations include:

- Higher per-test costs than laboratory assays
- Training and competency requirements for non-laboratory staff
- Need for robust quality assurance
- Integration challenges with electronic health records

Clinical Applications

POCT is now applied across multiple settings:
- Operating theatres: Blood gases, coagulation (INR, ACT), electrolytes, glucose, lactate [1,7]
- Intensive care: Blood gases, electrolytes, cardiac markers (troponin), CRP, haemoglobin, haematocrit [1,3]
- Neonatal units: Blood gases, haemoglobin, bilirubin, glucose [4]
- General wards/clinics: Glucose monitoring, urinalysis, rapid immunoassays (influenza, COVID-19, RSV), INR testing [6,8,9]

Technologies and Equipment

Modern POCT devices are portable, compact, and user-friendly:
- Blood gas analysers: Common in ICUs and theatres [1]
- Immunoassay analysers: Detect cardiac markers and infectious diseases [3]
- Handheld glucose/ketone meters: Standard in diabetes management [6]
- Coagulometers: Monitor anticoagulation therapy [7]

Challenges include device interoperability, data connectivity, and ensuring competency among diverse clinical users.

UK Market Landscape

Suppliers include:
- Radiometer: Acute care diagnostics, blood gas analysers [10]
- EKF Diagnostics (UK-based): Haemoglobin, glucose, lactate analysers [11]
- Roche Diagnostics: Broad POCT portfolio including glucose meters [12]
- Abbott: Manufacturer of the i-STAT handheld system [13]
- Woodley Equipment Company (UK-based): Supplies POCT devices for hospitals and clinical trials [14]

Procurement within the NHS is shaped by cost-effectiveness, interoperability, and alignment with national rapid diagnostic priorities.

Discussion

Near-patient testing has clear advantages in acute and chronic care pathways. Its contribution to faster decision-making and reduced hospital bottlenecks aligns with NHS priorities for efficiency and patient-centred care.

Nevertheless, challenges remain. Cost per test may exceed central laboratory processing, requiring cost-benefit evaluations to justify adoption. Training and governance structures are essential to maintain analytical quality. Moreover, integration into digital health records is critical to ensure results are accessible across care pathways.

Future developments are likely to focus on:
- Artificial intelligence to support interpretation and decision-making
- Full connectivity with NHS digital systems
- Expansion of POCT into community and home settings
- Multiplex devices capable of testing multiple analytes from minimal samples

Conclusion

POCT represents a transformative shift in diagnostic practice. By providing immediate results at the patient’s side, it enables earlier treatment, reduces errors, and supports efficient care. With ongoing technological advances and NHS commitment to rapid diagnostics, POCT is poised to expand beyond hospitals into community and home care, establishing itself as a cornerstone of modern diagnostics.

References

1. BMJ. Point-of-care testing in a busy intensive care unit. BMJ. 2008.

2. World Health Organization. Point-of-care testing: WHO guidelines. WHO Press. 2015.

3. New England Journal of Medicine. Point-of-care testing for cardiac biomarkers. N Engl J Med. 2018.

4. Neonatology Today. Point-of-care testing in the neonatal intensive care unit. Neonatology Today. 2017.

5. Emergency Medicine Journal. The impact of point-of-care testing on emergency department patient flow. Emerg Med J. 2019.

6. Diabetes Care. Clinical and economic impact of point-of-care testing for diabetes. Diabetes Care. 2016.

7. Anaesthesia. Point-of-care testing in the operating room. Anaesthesia. 2014.

8. Journal of Clinical Microbiology. Rapid point-of-care testing for influenza. J Clin Microbiol. 2020.

9. The Lancet. Point-of-care COVID-19 testing. Lancet. 2021.

10. Radiometer. Radiometer UK: Point-of-Care Testing. Available at: https://www.radiometer.co.uk [Accessed 28 Aug 2025].

11. EKF Diagnostics. EKF Diagnostics: Point-of-Care. Available at: https://www.ekfdiagnostics.com [Accessed 28 Aug 2025].

12. Roche Diagnostics. Roche Diagnostics: Point-of-Care Solutions. Available at: https://diagnostics.roche.com [Accessed 28 Aug 2025].

13. Abbott. Abbott: i-STAT Point of Care Testing. Available at: https://www.abbott.com [Accessed 28 Aug 2025].

14. Woodley Equipment Company. Clinical Point of Care. Available at: https://www.woodleyequipment.com [Accessed 28 Aug 2025].