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 led by South Central Ambulance Service and Oxford University Hospitals NHS Foundation Trust, 52% of patients who were initially identified as requiring hospital admission were successfully managed at home.
It was made possible by using specialist paramedics to take blood samples at the scene and discuss the results with hospital physicians remotely to determine the next steps.
Although specialist paramedics receive an additional two years’ education and training and are able to diagnose a wider range of conditions and treat many minor injuries and illnesses, they do not routinely assess blood test results.
As part of the trial they 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 novel wireless technology to transmit a 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.
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.
Critically unwell patients continued to be taken to hospital after assessment without having diagnostic blood tests and patients who did not require any further clinical input were referred to community services without participating.
The study, published in the Journal of Paramedic Practice, showed that over a three-month period the frailty response unit saw 42 patients who were either too critically unwell or not in need of hospital assessment and 56 selected for point-of-care testing.
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.
Dr John Black (pictured), Medical Director for SCAS and one of the study authors, 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.”
He added: “Serious consideration must be given to innovations such as this to ensure the best possible care and environment for patients but also to help address the ongoing issue of hospital pressures and capacity which continues to be such a significant problem.”
Dr Alex Novak, Consultant in Emergency Medicine and Ambulatory Care at Oxford University Hospitals NHS Foundation Trust and co-author of the study, 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.”
Issued: 16 March 2022