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illustration of multiple small blood test devices, doctors and drugs © Macrovector

New research from the University of Oxford and Oxford University Hospitals NHS Foundation Trust that assessed more than 100,000 point of care tests investigated the frequency of reported errors that could be attributed as operator error.

The study found that for the Abbott i-STAT, the most widely used device in the setting considered, 6.8% of attempted tests resulted in the machine reporting an error message, but only a third of these (2.3% of the total) were likely to be due to factors under the control of the operator. The most common reasons were adding too much or too little blood to the cartridge that is inserted into the machine.

While the impact of such errors on patient care is likely very low – errors are detected by the device and can simply be repeated – interviews with users suggested that improved staff training could overcome the issue.
Diagnosing and monitoring disease using venous blood samples is an important part of patient care in hospital settings. In community settings, such as ambulatory care, point of care testing allows doctors or nurses to get results from blood samples rapidly to guide a patient’s treatment.

Research and Information about point of care testing devices typically focuses on whether they give accurate results when used accordingly to manufacturers’ guidelines, rather than factors that may influence the way they are used in practice across different settings by different operators.

As we identify more and more opportunities to improve patient care by using point of care tests, it is important that we understand how these devices are working in real-life settings and what we can do to improve error rates.”
- Prof. Gail Hayward,  Deputy Director of the NIHR Community Healthcare MedTech and In Vitro Diagnostics Cooperative.

The study used a ‘mixed methods design’, combining an assessment of more than 100,000 point of care test uses between January 2016 and December 2018 with an analysis of interviews of staff who carried out point of care testing.

The interviews revealed that staff also identified cartridge filling as the most difficult part of conducting point of care blood testing, and suggested that errors could be reduced by training and practice. Cartridge filling errors could usually be resolved by refilling a fresh cartridge, suggesting that the impact of these errors on patient care was likely to be low, although this could not be assessed directly. Impact was more likely to affect resource use or the time required to obtain a test result.

Dr Thomas Fanshawe, a senior medical statistician at the University of Oxford, said: “This work adds substantially to the literature about the use of point of care devices and emphasises the benefits that might arise from using a mixed methods design. By doing so, we were able to assess not only the frequency of operator errors but also explore the reasons why they occurred, strengthening our overall conclusions.”

View the publication: 

Fanshawe TR, Glogowska M, Edwards G, Turner PJ, Smith I, Steele R, et al. (2020) Pre-analytical error for three point of care venous blood testing platforms in acute ambulatory settings: A mixed methods service evaluation. PLoS ONE 15(2): e0228687


The project was funded by the National Institute for Health Research (NIHR) Community Healthcare MedTech and In Vitro Diagnostics Cooperative, and supported by a grant from Becton, Dickinson and Company.


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