![]() This was commenced to support the visiting clinician in performing their assessment, including overcoming any practical barriers to phlebotomy where it was indicated.Ĭlinicians: Semistructured qualitative interviews were conducted with clinicians who had access to the POC testing equipment by SD (a GP and researcher). On six included shifts, a healthcare assistant (HCA), trained to measure vital signs and perform phlebotomy, accompanied the GPs. No guidance on test result interpretation was provided, but EPs could call a GP colleague for advice if needed. Clinicians were advised to use the tests when they felt it was appropriate to support their decision-making. General Practitioners (GPs) and EPs (a role performed by clinicians trained as either emergency nurse practitioners or paramedics) were trained to perform POC tests, with ‘champions’, who expressed an interest in supporting the intervention, appointed at each base to promote usage and offer additional training. At the time of the project, there was no validated portable C Reactive Protein (CRP) test available commercially so this test was not an available option for clinicians. The CG4 cartridge measures lactate, pH, PaO2 and PCO2, TCO2, bicarbonate, base excess and oxygen saturation. The Chem8 cartridge measures sodium, potassium, chloride, total carbon dioxide (TCO2), anion gap, ionised calcium, glucose, urea, creatinine, haematocrit and haemoglobin. 7 Two cartridges were available in this project. The i-STAT is a platform POC closed cartridge blood testing system which requires 95 µL of blood per cartridge and can be used with capillary, venous or arterial blood. ![]() The Abingdon and Oxford bases of the Oxfordshire OOH service were each supplied with two Abbott i-STAT devices with a staggered start: Abingdon began on 11 November 2016 and Oxford began on 7 January 2017. Within this, we embedded a qualitative study to gather information on clinicians’ views of having access to the POC tests in this setting and how they were used, and patients’ views of the POC tests being offered to them during OOH home visits. A quantitative study aimed to describe the usage of tests across the period of implementation. We employed a mixed methods design to evaluate this service improvement. In a service improvement project, we introduced POC tests giving immediate results from handheld devices into OOH primary care home visits in Oxfordshire. However, currently, blood POC testing in the home is limited to measurement of blood glucose levels 4 5Īccess to blood tests available rapidly at the point of care (POC) could support OOH clinicians who perform home visits in the early identification of patients with acute illness and in decision making regarding location of care. 2 3 Conversely, inappropriate admission to hospital for patients who could be managed in the community is expensive and poses risks from infection and functional decline. Patients can suffer from prolonged acute illness, incomplete recovery and increased mortality. ![]() 1ĭelayed escalation to hospital care is associated with greater risk of a poor clinical outcome for many conditions such as serious infections and acute kidney injury. Our previous work on OOH consultations found that admission due to deterioration after initial assessment was more than twice as likely in patients aged over 80 as those aged under 10, and more likely in patients assessed in their own home. For older patients living with frailty who develop an acute illness, assessments by OOH clinicians are often made in the patient’s home with critical decisions about escalation to hospital care being made with limited evidence. Out of hours (OOH) primary care involves high-risk decision-making, as clinicians assess patients with a high prevalence of acute illness without prior knowledge of the patient and with limited access to their background medical information and diagnostic tests.
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