Half of patients kept out of hospital in pilot paramedic blood testing scheme

A trial scheme by paramedics to provide blood testing at home for frail and elderly patients has resulted in more than half of the patients not needing to go to hospital.

Specialist paramedics from South Central Ambulance Service were given extra training to take blood samples at the scene and discuss the results with hospital physicians remotely to determine the next steps.

Potential patients aged 65 and older were identified by 999 call handlers and were then assessed by the paramedic at the scene and only non-critically unwell, frail or elderly patients were enrolled in the pilot study which worked with Oxford University Hospitals NHS Foundation Trust.

A SCAS spokesman said: “These patients then had bloods taken for immediate diagnostics in addition to the usual bedside investigations including urinalysis, electrocardiogram and blood sugar levels, with the results discussed with a senior physician by telephone for decision support.

“The outcomes were to either enable the patient to remain at home after a comprehensive assessment without the need for further intervention, leave the patient at home with further intervention from community or hospital at home services or transfer to hospital via the emergency department or acute medical unit.”

Out of the 56 enrolled, 27 were transferred for further assessment in hospital but 29 (52%) 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, according to the study published in the Journal of Paramedic Practice.

As part of the trial, the paramedics were given additional training in taking and handling blood samples and a SCAS rapid response vehicle (RRV) was equipped with a point-of-care – also known as bedside – testing device and wireless technology to transmit a patient’s blood results to hospital within minutes.

Dr John Black, SCAS medical director, said: “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.

“As well as the benefits of keeping frail and elderly patients out of hospital if clinically appropriate to do so, there is a real potential for this to relieve pressure and financial costs on busy hospital emergency departments and acute medical units.”

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