Point-of-care testing aids decision-making in a GP-based assessment hub

A new study conducted in primary care demonstrates how testing can avoid unnecessary hospital admissions and improve patient pathways. Here, Laura Mitcham explains how rapid assessment of full blood count and C-reactive protein contributed to the success of the project.

Oxford Academic Health Science Network (AHSN) has recently published the results of a study exploring the use of point-of- care testing (POCT) within a pioneering GP group practice. The study commenced in January 2019, aimed at relieving winter influenza pressures and to meet local Clinical Commissioning Group (CCG) demands to reduce unnecessary hospital visits and admissions. The study demonstrates tangible benefits for clinical decision-making and cost savings, and the current pressures on health services render the findings even more relevant today.

Overview The Brookside Group Practice in Lower Earley, Berkshire, had already introduced a new model for its patient pathway by creating a multidisciplinary, paramedic-led urgent care clinic with the aim of retaining patients in a primary care setting where possible. This service was the subject of an in-depth audit and evaluation, working alongside the AHSN, which demonstrated that this model provided a reduction in waiting times, more efficient referrals, and cost savings of between 4% and 38%.1 The introduction of pathology POCT represented the second phase of the project to enhance still further their decision-making process. A prior study by Oxford AHSN that evaluated the adoption of the Microsemi


CRP (HORIBA Medical, France) in paediatric urgent care showed that the instrument could enable more rapid clinical decision-making, saving time and reducing costs.2

sepsis, distinguish between bacterial and viral infection, and also establish the severity of disease. The analyser was placed alongside the i-STAT Alinity (Abbott), which was supplied with CG4+ cartridges to measure abnormal lactate levels, monitor tissue hypoxia and perform urea and electrolytes (U&E), and CHEM8+ cartridges to detect blood chemistry abnormalities, primarily renal function and dehydration.

The study investigated whether or not Economic analysis found

that this could result in net annual cost savings due to reduced staff time, as well as faster decisions on antibiotic use. This instrument was therefore selected for use at the Brookside urgent care unit. The Microsemi CRP requires just 18 µL of a single sample of whole blood to deliver the simultaneous measurement of full blood count (FBC), including three-part differential, and C-reactive protein (CRP) within four minutes. The combination of CRP, an inflammatory marker, and white blood count (WBC) plus granulocyte count, helps to identify

the introduction of POCT could support the clinical decision-making process for a range of urgent care needs, increase clinical confidence in diagnosis within the urgent care clinic, and lead to more appropriate patient referrals to secondary care, with indicative modelling of the resulting financial impact. The decision to run one or more point-

of-care tests was based on the clinical judgement of the patient’s condition by the healthcare professional at the time of presentation.

Evaluation The study, carried out between January and July 2019, performed 133 tests on 102 patients, a relatively small proportion

Patient attendance at urgent care clinic

Clinical examination on attendance Clinical uncertainty – pre-POCT treatment/management plan noted

Supervising GP able to review patients, sign prescriptions and provide

additional support as required

POCT conducted – sample obtained from patient and run on analyser

Post-POCT treatment/management plan agreed and recorded

Patient pathway using point-of-care testing. DECEMBER 2020 WWW.PATHOLOGYINPRACTICE.COM

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