Point-of-care testing has allowed pathology at Treliske Hospital, Truro, to evolve its service to meet the needs of patients and colleagues in remote locations, as Helen Hobba and Louise Silver explain.
The Royal Cornwall Hospitals NHS Trust, with acute sites at Truro, Hayle and Penzance, covers a wide geographical area, including the Isles of Scilly. It serves around 450,000 people, a figure more than doubled by holidaymakers during the busiest times of the year. The role of the point-of-care (POC) testing team based at the main trust site in Truro has expanded over the past few years, and recent events have seen strong links established with the Urgent Care Centre (UCC) at the West Cornwall Hospital in Penzance, where medical staff undertake various time-critical POC tests.
The UCC is a year-long pilot project set up to provide ‘middle ground’ emergency care for patients with minor injuries and acute illnesses living in more remote regions. The Penzance model is being followed with interest by other hospital trusts hoping to adopt similar strategies. The UCC has two components: 24/7 accident and emergency (A&E) services and a separate urgent-care GP clinic, manned by acute GPs employed by the hospital trust who diagnose, treat and discharge patients when clinically appropriate, reducing unnecessary hospital admissions. Both services depend on POC testing to speed the patient pathway without having to wait for results from the pathology laboratory in Truro, and even patients who are then transferred to the main site will already have baseline measurements available to inform the team receiving the patient; this is particularly relevant for suspected myocardial infarction and DVT in adults, meningitis in children, or patients with acute asthma. Tests are also carried out for the two acute medical wards, theatres, out-patient clinics, including the oxygen clinic and the renal unit (for potassium levels), generating as many as 80 samples each day. Simple and robust care pathways with easy-to-use analysers have been developed notably for blood gases, cardiac (troponin T) and clotting (D-dimer) markers and inflammation (C-reactive protein [CRP]).
Fast turnaround of results
The POC blood gas analyser chosen for the UCC (Radiometer ABL90 FLEX) is also found in various units at Treliske Hospital, and is used to full effect in ITU, A&E, medical admissions, paediatric HDU, the neonatal unit and theatres, as well as in pathology. A similar system (ABL800 FLEX) is also used in the delivery suite for assessment of fetal blood scalp samples (35 µL). Now, the laboratory receives only the occasional request for blood gases, leaving time for other, more specialised analyses and also reducing the workload for out-of-hours staff. This makes a great deal of sense for measurements that depend on rapid turnaround; blood gas analysis on the nearest POC analyser is typically four times faster than taking a sample to pathology to be processed.
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