References
Point-of-care blood tests in decision-making for people over 65 with acute frailty
Abstract
Background:
National ‘see, treat and discharge’ rates for paramedics have increased. However, despite the rise in demand on paramedic decision-making, there have been few improvements to prehospital diagnostics. Patients aged over 65 years presenting with acute frailty syndromes are a notably complex clinical patient group for whom informed risk stratification in clinical reasoning is paramount.
Methods:
This was a single-site quality improvement project using point-of-care blood testing (POCbT) to help inform decision-making for patients aged above 65 years with acute frailty syndromes.
Results:
This quality improvement project showed a self-reported improved confidence in clinician decision-making and patient disposition with the use of POCbT. This confidence was validated by improved discharge on scene and recontact rates. An unintended outcome of the project was the accumulation of practical knowledge on the use of POCbT in the prehospital arena.
Conclusion:
Continued use of POCbT in the prehospital environment has promise but this is not without limitations. Prehospital services wishing to implement POCbT should focus on demographic identification, staff training and interpretation of results.
Point-of-care blood testing (POCbT) is an expanding worldwide market (Goodwin, 2008) and has become an established part of service improvement proposals within the NHS to reduce emergency department (ED) wait times and length of hospital stay, as well as improve illness prevention schemes (Hart, 2017). In the UK, point of care international normalised ratio (iNR) testing in primary care has been a topic of research since the early 1990s (Fitzmaurice, 2004) and point of care lactate monitors are being trialled for guided therapy for early sepsis (Morris et al, 2017). UK ambulance services have been identified as a service that would benefit from POCbT to guide patient management and care pathways (Di Serio et al, 2006; 2010; Goodwin, 2008). However, little evidence on the uses, benefits and health economics of POCbT in the prehospital environment has been published.
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