Point-of-care blood tests during home visits by out-of-hours primary care clinicians A mixed methods evaluation of a service improvement

Funded by

The Health Foundation Logo

15 January 2020

Published journal: British Medical Journal

Abstract

Objectives 

We aimed to evaluate test usage and patient and clinician experience following the introduction of point-of-care (POC) blood tests into a primary care out-of-hours service.

Design 

A mixed methods service evaluation comprising quantitative records of the clinical contexts of tests taken and qualitative interviews with clinicians. Research permissions and governance were obtained for patient interviews.

Setting 

Out-of-hours primary care.

Participants 

All patients requiring home visits from the service during the implementation period.

Interventions 

The i-STAT POC blood test platform was introduced to two bases providing home visits for a period of 8 months. Venous blood samples were used and two cartridges were available. The CHEM8 cartridge measures sodium, potassium, chloride, total carbon dioxide (TCO2), anion gap, ionised calcium, glucose, urea, creatinine, haematocrit and haemoglobin. The CG4 cartridge measures lactate, pH, PaO2 and PCO2, TCO2, bicarbonate, base excess and oxygen saturation.

Primary and secondary outcome measures 

The proportion of home visits where tests were taken, the clinical contexts of those tests, the extent to which clinicians felt the tests had influenced their decisions, time taken to perform the test and problems encountered. Clinician and patient experiences of using POC tests.

Results

i-STAT POC tests were infrequently used, with successful tests taken at just 47 contacts over 8 months of implementation. The patients interviewed felt that testing had been beneficial for their care. Clinician interviews suggested barriers to POC tests, including practical challenges, concerns about time, doubt over whether they would improve clinical decision making and concern about increased medicolegal risk. Suggestions for improving adoption included sharing learning, adopting a whole team approach and developing protocols for usage.

Conclusions 

POC tests were not successfully adopted by an out-of-hours home visiting service in Oxfordshire. While some clinicians felt they could not add value, in other cases they resulted in improved patient experience. Adoption could be promoted by improving technical, team and education factors.

Citation

Hayward G, Dixon S, Garland S, et al, Point-of-care blood tests during home visits by out-of-hours primary care clinicians; a mixed methods evaluation of a service improvement, BMJ Open 2020;10:e033428.

You might also like...

Event

The Shuri Network and Health Foundation virtual lunch and learn

Event

Join our lunch and learn session focused on empowering black, Asian and minority ethnic women in...

Journal article

Evidence use as socio-material practice

Journal article

Identifying three socio-material mechanisms through which evidence and context shape each other in...

Newsletter feature

Exploring the potential of AI to help address health inequalities

Newsletter feature

Brhmie Balaram from NHSX and Adam Steventon from the Health Foundation discuss the new £1.5m...

Kjell-bubble-diagramArtboard 101 copy

Get social

NEW: Our analysis explores the connection between #mentalhealth and unemployment, and why action on both is needed… https://t.co/ZJ9v4JhLBd

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more