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Need for hospital transfers halved in trial of home blood testing for frail and elderly

18/03/2022
This article is more than two years old.

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 by Oxford University Hospitals (OUH) NHS Foundation Trust and South Central Ambulance Service (SCAS), 52 percent of patients who were initially identified as requiring hospital admission were successfully managed at home.

This reduction was achieved by specialist paramedics taking blood samples at the scene and discussing the results with hospital clinicians remotely to decide on the next steps.

Specialist paramedics do not routinely assess blood test results, so those taking part in the trial were given additional training in taking and handling blood samples and a SCAS rapid response vehicle (RRV) was equipped with a point-of-care - or 'bedside' - testing device and wireless technology to transmit the patient's blood results to hospital within minutes.

Potential patients were identified by 999 call handlers as requiring more detailed clinical assessment and selected if they were 65 years or older and had either fallen from a standing height without obvious injury, had collapsed, were confused, had reduced mobility or suspected infection.

They were then assessed by the paramedic on scene and only non-critically unwell frail or elderly patients who were deemed to potentially require transfer to hospital for further investigation were enrolled in the study to see if they could be managed safely at home.

After the blood tests and usual bedside investigations, and a discussion with a senior physician at the hospital, a decision was made to either allow the patient to remain at home without the need for further intervention; leave them at home with further intervention from community or hospital at home services; or transfer them to the hospital Emergency Department or acute medical unit.

Critically unwell patients were taken to hospital after assessment without having diagnostic blood tests, while patients who did not require any further clinical input were referred to community services without participating.

The pilot study, published in the Journal of Paramedic Practice, showed that of 56 patients selected for point-of-care testing, 27 were transferred for further assessment in hospital but 29 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.

The lead author on the study, Dr Alex Novak, OUH Consultant in Emergency Medicine and Ambulatory Care, said: "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."

Dr John Black, SCAS Medical Director and one of the study authors, added: "These results suggest it is feasible to perform bedside diagnostics in the community as part of the clinical assessment offered by ambulance services and that a proportion of older patients could potentially be managed in a home or community setting without physically attending hospital and without adding significantly to the burden on community services.

"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."

Pictured: SCAS rapid response vehicle with testing kit