Phillip Weihser BSc. PGCert. MSc. Divisional Operation Manager James Paget University Hospital Great Yarmouth, United Kingdom Process Redesign in Ambulatory Emergency Care Utilising Point of Care Testing This Speaker Program is sponsored by, and on behalf of, Abbott and the content of this presentation is consistent with all applicable FDA requirements For In Vitro Diagnostic Use Only 1510.REV1
Disclaimer The results shown here are specific to one health care facility and may differ from those achieved by other institutions.
Introduction: Opened in 1982 Patient catchment area of 240,000 3,600 employees with 34,000 Elective and 67,000 ED admissions per annum Budget of 160 million; facing increasing operational pressures due to static year-onyear funding
National Perspective: AEC shown to play vital role in decreasing hospital length-ofstay Conventional admission streams cost the NHS 1.24 billion yearly; associated decrease in 1,2 and 3 LoS could save an 683.8 million Focus on Zero admissions Laboratory testing accounts for 4% of total budget, influencing 66% of healthcare costs
What does experience tell us? Lack of a clear plan for every patient System designed to make patients wait Capacity (staff) not calculated to meet demand Frequency of interventions not designed to meet demand The system is not properly understood Push over process.
What should our focus be What creates value from the patient s perspective Helps make a diagnosis Helps improve a patient s condition or circumstances Gets the patient to the correct destination Make those actions that create value flow by removing waste Strive for perfection by continually removing successive layers of problems
Systematic Approach: Evidence-based methodology: Define value What really matters to deliver this value? Process Activity Mapping Demand mapping Make performance visible Redesign work processes eliminate delay Failure Mode and Effect Analysis
Pilot Study Design: Partnership with Abbott POC and Operasee Limited Multi-disciplinary project team; supported by Exec level sponsorship POCT viewed as an enabler not stand-alone Process Ownership And most importantly.
Project Planning: Update daily, Avoid deviation, Include issues log and document causes of delay
POCT Cluster: Fulfilling >85% of patient needs: Sysmex XS-1000i: Full Blood Count; Radiometer AQT90: D-dimer; Abbott i-stat System with CHEM8+, CG4+ and PT/INR POCT does not stand-alone Controlled POCT use: Continually monitored System Effectiveness See intended use section for complete cartridge information For In Vitro Diagnostics use only
Connectivity: Condition for successful POCT implementation: Documentation Cost-effectiveness Accreditation Improve quality/management of POCT solutions Utilising Conworx POCcelerator: Result/IQC/EQA monitoring Controlled access Bi-directional POCTo1-A2 Compliant: Multi-vendor interoperability Adoption
Results: Pilot data: Total Patients Average Patients/Day Mean LoS (mins) Conversion Rate Month 1 101 5.05 127 11.88% Month 2 143 6.5 161 14.69% Month 3 181 9.05 150 18.23% Achieving: LoS of AMU decreased from 1.04 to 0.8 bed days; only 26.06% seen in AmbU Mean LoS reduction 40.8% (250 minute baseline) 8.22% increase in zero admissions; 8.93% reduction in 1,2 and 3 day LoS admissions
Business Case: Very little published data regarding POCT cost-effectiveness in the UK. Significant reduction in tariff income for this patient co-hort. Operation modelling essential! Quantification of stepped costs. Cost benefit to the Trust of 1.098 million; CCG saving 557,088.
Business as Usual: Mean LoS: 114 minutes 17.93 patients/day Nurse R/V: 8 mins; SCDM Decision: 46 mins 52% of EADU take seen during equivalent opening times 6.22% conversion rate; 93.78% same-day discharge rate Approved business case and bespoke new-build environment
Performance: No increased demand with 326.58% rise in zero admissions Static 30-day readmission rates (7.20% - 4.89% Ward/2.31% AmbU) Attainment of key performance indicators; including patient experience and mortality rate reduction (5.45% to 0.54%)
Additional Impact: 25.47% reduction in patient movement into hospital Reduced medical outliers Enhanced elective capacity significant additional performance
POCT Benefit Realisation: Value of POCT tangible change Data Integration decision making Treatment/Diagnosis optimisation Evidence-based ISO 22870 compliance Continuing user-confidence Service assurance
The Now! Extended opening hours 7-day services commencement Static readmission rates Enhanced recruitment Scaling-up to capture entire inpatient acute medical cohort Front-to-back process change Standardisation with reduced variation
Intended Use Information (CG4+) Lactate The test for lactate, as part of the i-stat System, is intended for use in the in vitro quantification of lactate in arterial, venous, or capillary whole blood. The i-stat lactate test is useful for (1) the diagnosis and treatment of lactic acidosis in conjunction with measurements of blood acid/base status, (2) monitoring tissue hypoxia and strenuous physical exertion, and (3) diagnosis of hyperlactatemia. PT/INR The i-stat PT, a prothrombin time test, is useful for monitoring patients receiving oral anticoagulation therapy such as Coumadin Coumadin is a registered trademark of Bristol-Myers Squibb
Any questions? Many thanks for listening Abbott Point of Care Inc. 400 College Road East Princeton, NJ 08540 609-454-9000 609-419-9370 (Fax) www.abbottpointofcare.com 1510.REV1 Sponsored by