What was the challenge?
The Evelina London Children’s Hospital PED has attendances of around 30,000 children under 16 years old per annum. Following an audit of turnaround for hospital laboratory samples, we decided to review the availability of point of care diagnostics, as part of a suite of improvement projects to help manage an increase in attendances.
What did you do?
Following the results of a project undertaken by the Oxford Academic Science Network (see below), we sourced a HORIBA Diagnostics Microsemi C-reactive protein (CRP) analyser through a contract hire agreement. This is able to analyse a paediatric whole blood EDTA (ethylenediamine tetraacetic acid) sample (18 microlitres), producing a full blood count (FBC) with 3 point differential plus CRP in under four minutes.
We undertook a period of validation. During this phase the point of care diagnostic results were referenced against routine laboratory testing to check their accuracy and acceptability. The validation period also allowed us to establish strong clinical governance policies for this initiative.
What was the impact?
After the validation period, FBC and CRP results were routinely available within four minutes of sampling. This was opposed to over 60 minutes for laboratory results becoming available
Point of care diagnostics has led to improved flow of patients through the PED for those patients whose FBC and CRP results were rate-limiting in the ED pathway.
The cost per test is equivalent to or slightly less than the cost of routine laboratory testing. This approach supports real time decision making, and also improved patient and staff satisfaction with diagnostic turnaround.
Robust governance and user policies are required to both maintain and quality control point of care diagnostic devices. There are resource implications required to support this.
This initiative was informed by a project undertaken by the Oxford Academic Health Science Network. More information is available via the link below.
Reference: Can using point of care blood tests in emergency paediatric units improve quality of care? Dr Craig McDonald (Stoke Mandeville Hospital), Dr Joanne Philpott (Wexham Park Hospital), Dr Shelley Segal (John Radcliffe Hospital), Julie Hart (Oxford Academic Health Science Network). www.healthandwealthoxford.org
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Disclaimer: RCPCH have been notified that the above is a good example in managing winter pressures in emergency departments and will be reviewed on a regular basis. Sharing examples does not equate to formal RCPCH endorsement.