Point-of-care testing by paramedics using a portable laboratory: an evaluation
Abstract
Use of point-of-care testing (POCT) equipment by paramedics for triage may reduce unnecessary attendance in emergency departments and inconvenience to patients. A hospital pathology service and an ambulance trust wanted a system for safe and effective use of diagnostic devices by paramedics at the patient bedside. A suite of POCT devices to perform an expanded repertoire of pathology tests was provided, along with technology for electronic data capture, temperature control and monitoring, in a specially designed kit bag—the Labkit. Following a proof-of-concept phase, three Labkit bags were deployed as a pilot in rapid response vehicles and used by specialist paramedics in urgent and emergency care who had been trained in their use. The paramedics used the bag in 25% of patient interactions, typically three times every 24 hours. Having POCT results available at the time of paramedic assessment reduced conveyance to the emergency department by 21%. There was also a 10% rise in admission of patients where pathology results indicated problems that required urgent treatment which would otherwise have gone unnoticed. Overall, 31% of conveyance decisions were changed as a direct consequence of the Labkit results. Patients reported high levels of satisfaction, and paramedics said it added value in 97% of cases where it was used to support decision-making. Reliable, quality-assured POCT by paramedics has the potential to improve efficiency in the healthcare system and benefit patients.
Growing pressures on emergency departments (EDs) and ambulance services in the UK have increased the need for new approaches that can help paramedics to triage patients in a variety of settings outside hospital. These intentions, which were set out in the Bradley reports (Department of Health and Social Care, 2005; Association of Ambulance Chief Executives (AACE), 2011) and confirmed as a policy objective in Transforming Urgent and Emergency Care (NHS England, 2015) are consistent with objectives of the NHS (2014)Five Year Forward View and remain largely unfulfilled.
The National Audit Office's (2017) study of ambulance services reported that the ambulance service's progress in modernising and implementing a model of care where paramedics deliver more ‘see and treat’ services had been patchy. The wide variation in conveyance rates and the resulting implications for efficiency and patient safety were raised again as an urgent matter requiring resolution in Lord Carter's Operational Performance and Productivity in English Ambulance Trusts: Unwarranted Variations (NHS Improvement, 2018).
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