Overview

Wokingham Community Hospital purchased two difference Point of Care (POC) diagnostic test devices for its elderly inpatient unit to evaluate the impact of speedier test results on helping nurses make effective decisions regarding treatment. They purchased the QuikRead go CRP machine and the Abbott i-STAT Alinity. The QuikRead go CRP machine provides a rapid blood test for the quantitative determination of C-reactive protein that shows the presence of inflammation or infection in the patient, while the i-STAT Alinity is a portable blood testing machine with a cartridge for urea and electrolytes (U&Es) which nurses used to assess kidney function.

The availability of the tests allowed healthcare professionals to rapidly diagnose patients, and make better treatment decisions in a timely fashion, which other studies have shown to potentially reduce average length of stays in frail elderly patients once they’d been admitted to hospital.

The Oxford AHSN assisted by reporting the economic cost-consequence analysis of the two tests, determining the cost benefit to the hospital and extrapolating the benefits to other community hospitals.

Challenge / problem identified

For most of the community hospitals in Berkshire Healthcare NHS Foundation Trust, blood samples are sent to the pathology department. This can often be a lengthy process (with average turnaround time being 24 hours) and can lead to a delay in diagnosis and first-line treatment.

These delays in diagnosis and treatment have been shown to increase the average length of stay for frail elderly patients and potentially poorer immediate outcomes, which also severely impacts on their future health and quality of life, as well as taking up capacity in the hospital setting that could be used for other patients.

Actions taken

The Oxford AHSN performed a literature review and secondary research to identify the current care pathway and provided a cost-consequence analysis to assess the impact and potential benefits of using the two POC devices in a community hospital setting and assess whether the use of the devices results in net savings across the five community hospitals in Berkshire.

Wokingham Community Hospital supplied the Oxford AHSN with cost and population data that was used to identify the cost savings by reduced ED referrals from Wokingham Community Hospital due to the implementation of the POC devices in the care pathway.

This analysis will then be used to inform the business case to support the procurement of these POC devices at Wokingham Community Hospital and potentially roll out to other community hospitals within Berkshire Healthcare.

Impacts / outcomes

The result of the analysis suggests that the implementation of the POC devices in the community care pathway results in better patient management and cost savings. During the three months of the study there was a significant reduction in patient referrals to ED.  The total cost saving from the POC devices was ~£10,000 for a three-month period. When the devices were not in use there were a minimum of 30 patients referred to ED. With the implementation of the POC in the care pathway over a three-month period there was a reduction by 83% of ED referrals, with only five referrals.

POC for both U&Es and CRP was shown to help in better patient management at Wokingham Community Hospital leading to improved patient prognosis. If patients are managed efficiently with quick diagnosis at the community hospital, it helps reduce referrals to the ED. The study suggests that once admitted, people with a need for social care often experience long stays in hospital, which may increase their risk of experiencing an event with an adverse health impact, such as an infection. The benefit of avoiding emergency admissions may, therefore, be particularly high among people with a need for social care, from the perspective of both the patient and the NHS.

Patient impact

POC devices are decreasing the time to diagnose illnesses and patients are getting correct treatment more quickly. This reduces pressure on the NHS as the treatment is quicker and often means the patient doesn’t have to be transferred to ED for quick diagnosis, and frequently results in better health outcomes for patients.

Plans for the future

Wokingham Community Hospital has evaluated these devices and other community hospitals in the Berkshire Healthcare NHS Foundation Trust are looking at implementing them into the care pathway. No timescales have been set for this.

Which national clinical or policy priorities does this example address?
  • Care and Quality
  • Funding and Efficiency.
Where did the innovation originate from?
  • NHS
Which AHSN Priorities does this example cover?

New care models (including supporting accountable care organisations and vanguards).

Start and end dates

May 2019 – November 2019.

Project contact for further information

Mamta Bajre, Lead Methodologist, Oxford AHSN, mamta.bajre@oxfordahsn.org

Media contact for further information

Ruby Urwin, Digital Marketing Manager, Oxford AHSN, ruby.urwin@oxfordahsn.org