Case Studies

Redesigning the process in the ambulatory emergency care at James Paget University Hospital

A study of emergency admissions in England found that over a quarter of admissions did not require an overnight stay (length of stay [LoS] of zero).1 This suggests that many emergency patients could benefit from ambulatory emergency care (AEC)1 by having a Systematic approach to process redesign. This entails immediate access to urgent care that would usually require the resources and expertise available in an acute hospital.2

Integrated POCT devices, such as the i-STAT System™, are likely to offer more options for managing patients in an AEC setting

450_x_300_2CT_Emergency_Entrance.jpg
Key Metrics

 

Goal

Reduce LoS for patients

IMPROVEMENT

60% decrease in LoS (half year post-redesigned process)

Goal

increase in patients with 0 day LoS

IMPROVEMENT

25% less admissions
 

Goal

Economic benefit

IMPROVEMENT

more than £1 million per annum

heart monitor Ghosted
 

POCT fulfilled over 85% of patient diagnostic needs in the AEC setting.3


The i-STAT System, in particular, was used for a variety of common tests, with the following cartridges used most widely:3
  • CHEM8+ to test blood electrolytes, basic haematology parameters and TCO2
  • CG4+ to test lactate and blood gases
  • PT/INR to test prothrombin time (a measure of blood coagulation)

1. NHS Institute for Innovation and Improvement. Ambulatory care directory for adult patients. 2009.
2. Royal College of Physicians. Acute Medical Care – the right person, in the right setting – first time. Report of the Acute Medicine Task Force 2007. London. Available at: www.rcplondon.ac.uk/sites/default/files/documents/acute_medical_care_final_for_web.pdf [Accessed July 2016].
3. Weihser P. Utilising POCT and Service Redesign to Establish an Ambulatory Emergency Care Service. James Paget University Hospitals – NHS. September 8, 2015. [Unpublished presentation].

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