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CASE STUDY


of the 7580 patients who attended the urgent care pathway during the period of the evaluation but representing some of the more challenging cases. Following staff training, the analysers were operated by various clinical staff (ie GPs, nursing staff and paramedics), which demonstrated the ease with which the instrumentation could be operated.


Study results


When examining the data, use of POCT was found to have confirmed the original management plan on 57 of the 102 occasions it was used, and to have altered the management plan on 45 occasions. In some instances, a patient’s condition necessitated referral to secondary care for further investigation or treatment. The possibility of referral to secondary care occurred in 37 of the 102 instances when POCT was used during the evaluation. As well as confirming an initial plan to refer, POCT also contributed to saved referrals (ie when a referral would originally have been requested) and possibly more importantly for patient care, led to a referral being made or expedited based on the POCT result when previously it had not been considered. Clinical staff reported increased confidence, both in reinforcing their initial diagnosis (56% of the occasions POCT was used) and more importantly in providing additional clarity in cases of diagnostic uncertainty (44% of the occasions POCT was used). The findings of this study mirror those of the previous AHSN evaluation using the Microsemi CRP in a paediatric emergency care setting where the patient pathway was compared in scenarios with and without POCT in three hospitals from late 2015 into 2016. This previous study2


found


that using POCT as a replacement for laboratory tests resulted in earlier decision-making in approximately 75% of cases across the sites. The study also demonstrated enhanced decision-making regarding the use of antibiotics in approximately 52% of cases at one site and 65% at another. Health economics mapping showed that the use of the instrument would result in a net annual saving for each of the three hospitals involved.


Potential cost savings in the latest


AHSN Brookside report were explored by analysing the cost of testing and potential cost of secondary care referrals against the instances where referrals were avoided. This cost analysis revealed


The Microsemi CRP analyser has been installed across various primary and secondary care settings, and is operated by multidisciplinary healthcare teams.


savings of over £3000 for the 102 patients included in the trial. Extrapolating this, the adoption of POCT was shown to predict a potential saving of £26,582 per annum.


Discussing POCT However, barriers exist to the adoption of POCT in primary healthcare, partly due to funding and also because of the need to ensure the quality of the results that inform the decision-making process. Organisations such as the AHSN have an important role in evaluating these pathways and demonstrating their efficacy. External quality assessment schemes and involvement of pathology POCT leads can also facilitate their safe operation.


Feedback from


The Microsemi CRP analyser from HORIBA Medical.


healthcare professionals involved in this latest evaluation reported that the availability of a POCT


result allowed them to have a more meaningful or specific discussion with the patient about the diagnosis being made, and that patients tended to accept the result of a test more readily than the clinical opinion of the medical professional alone. In a small number of instances where a secondary care referral was avoided, it was reported that the patients were immensely relieved and pleased not to have to go to hospital, which was an outcome they were dreading, as they could be treated at home.


The Microsemi CRP analyser has been installed across various primary and


WWW.PATHOLOGYINPRACTICE.COM DECEMBER 2020


secondary care settings, community hubs, emergency departments and assessment units, and is operated by multidisciplinary healthcare teams. C-reactive protein testing has been demonstrated to be a useful indicator of severity for COVID-19 patients,3


in addition to the more general


application of the instrument’s parameters in patient triage. The current SARS-CoV-2 pandemic has


provided a catalyst to explore different models for delivering care efficiently. This, and studies like the one produced by Oxford AHSN, has the potential to help shape the future of primary care.


PPi


References 1 Checketts G, Okhai N, Bajre M, Sharma A,


Edwards A, Hart J. Introducing point of care (POC) testing in a primary care urgent care pathway to improve clinical service delivery. Oxford Academic Health Science Network, 2020.


2 McDonald C, Philpott J, Segal S, Hart J. Can using point of care blood tests in emergency paediatric units improve quality of care? Oxford Academic Health Science Network, 2017


3 Siatka C, Eveillard M, Nishimura J, Duroux C, Ferrandi G. COVID-19 screening, prognosis and severity assessment with biomarkers for management of patients. HORIBA Medical White Paper, 10 April 2020.


Laura Mitcham is a Sales Specialist at HORIBA UK.


For further information, please contact: HORIBA UK - Medical Kyoto Close, Moulton Park Northampton NN3 6FL, UK Tel: +44 (0)1604 542650 Fax: +44 (0)1604 542651 Email: enquiries.uk@horiba.com Web: www.horiba.com/uk/medical


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PATHOLOGY IN PRACTICE


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