Blood tests were analysed alongside urinalysis, an ECG and blood sugar levels.
A trial of paramedic-led home blood testing for frail and elderly patients who required an ambulance helped to prevent the need for transfer to hospital in more than half of cases.
In a pilot study led by South Central Ambulance Service and Oxford University Hospitals NHS Foundation Trust and published in the Journal of Paramedic Practice, found that 52% of patients who were initially identified as requiring hospital admission by 999 assessors were successfully managed at home.
Paramedics involved in the study were trained to take blood tests and analyse these using a i-STAT portable clinical analyser. The blood results, alongside a urinalysis, ECG and blood sugar levels, were then transmitted to the hospital and discussed with an on call senior acute medical assessment physician.
After the comprehensive assessment patients either needed no further intervention, were referred to primary care services or transfer to hospital via the emergency department or acute medical unit.
Out of the 56 enrolled in the trial, 27 were transferred for further assessment in hospital but 29 (52%) remained in their usual care environment. Of these, four presented to hospital within the next 30 days but with no adverse events recorded as a result of non-transfer to hospital.
Reducing hospital pressures.
Dr John Black, Medical Director for SCAS and one of the study authors, said the results suggest it is feasible to perform bedside diagnostics in the community as part of the clinical assessment.
Mr Black continued; “The beauty of this model is that the potentially complex interpretation of the blood tests is undertaken by a hospital medical team remotely who can contextualise the results with the paramedic’s clinical findings and observations in the community at the time of referral.
“As well as the benefits of keeping frail and elderly patients out of hospital if clinically appropriate to do so, there is a real potential for this to relieve pressure and financial costs on busy hospital emergency departments and acute medical units.”
Mr Black also suggested a role out could help address the ongoing issue of hospital pressures and capacity.
Consultant in Emergency Medicine and Ambulatory Care at Oxford University Hospitals NHS Foundation Dr Alex Novak added; “This pilot project demonstrated the feasibility of providing linked community-based diagnostic testing with acute secondary care decision support and indicates the potential for this to have a positive impact on the healthcare provided to some of our most vulnerable patients.”
The small scale study now needs a larger pilot to validate the results.
