The big question

We know how hard your job is. Working in the community, you don’t always have access to the sort of equipment you need, but you still have to make critical decisions about patient care. Hospitalising patients isn’t anyone’s first choice, but without the means to test for blood gases there isn’t usually a viable alternative.

So, here’s our question to you: how much more could you achieve for your patients if you had the means to monitor and manage patient’s blood gases in the community? Our seminars don’t just raise the issue for discussion; they offer a real, practical and easily implementable solution…

One innovative solution

It’s called the Abbott i-STAT®: an easy-to-use, hand-held device that delivers laboratory standard results, using a very small sample of blood.

The i-STAT® gives you the power to make absolutely accurate assessments of blood gases and electrolytes in minutes. And because testing can be carried out in your patient’s local surgery or even in their own home, hospitalisations are greatly reduced. Caring for patients with COPD is one of the UK’s most significant healthcare expenses. So this is going to save your PCT a significant amount of money per patient, per year.

Do more for patients

Whether you’re already an i-STAT® user or not, both seminars will help you do so much more for your patients. Through case studies you’ll see how its transforming the way we think about administering care to COPD patients within the community. And through practical accounts from your peers, you’ll see how use of the i-STAT® has re-written the rulebook on COPD patient care.

After all, that’s your bottom line – patient care always comes first. And the beauty of the i-STAT® is that with such accurate blood gas testing data at your fingertips, you can regulate medication levels more precisely than ever before. Patients won’t just feel better; they’ll feel more confident that their medication is perfectly balanced because they will have seen it’s been based on the most up-to-date information available.

Equally, by removing the threat of unnecessary hospitalisation, patients’ stress levels are reduced. For many patients, that will act as a significant boost to their perceptions of their own health – and enhance their quality of life.

Register for your free place today

We’ve picked locations that should give as many of you as possible the chance to attend:

16^th March 2010

Rose Bowl Conference Centre, Leeds

18^th March 2010

1, Queen Anne’s Gate in London

So what can you expect? Both events will feature a selection of case studies that show how having the ability to perform blood gas testing at the point of care has been hugely beneficial to patients and their carers. Other case studies will look at ways of improving home oxygen services – something we know a lot of you will be very interested in. We’re also planning to include the latest update on interpreting blood gas results. In addition, there will be plenty of practical help and information available on using your i-STAT® for the first time, or, if you’re an existing user, on getting the best possible use out of it.

Remember, both events are absolutely free. We’re looking on them, as we hope you do, as a chance to pool our ideas and find even more ways to enhance the patient experience. And we’re sure that those of you who’ve been using i-STAT® for some time will have plenty to share on the sort of improvements you’ve already been able to make.

Here’s why you need to attend:

If you’re an existing i-STAT® user, you’ll pick up new tips and gain greater insight through case studies and discussion.

• If you’re new to i-STAT® you’ll hear first-hand accounts of how it has changed the whole experience of dealing with COPD patients in the community.
• If you’re a funding manager, you’ll discover how this portable application of existing hospital technology is leveraging huge saving for PCTs.
• If you’re looking for an innovative approach to effective management of COPD and respiratory disease you’ll get it; i-STAT® also offers testing for electrolytes, chemistries, coagulation, haematology and cardiac markers.

Reserve your place now

To reserve your place on either seminar, or simply to talk over what we’ve got planned, give Sue Younghusband a call on 01480 862100, or e-mail her at: sue.younghusband@axis-shielduk.com.

Come and join us, and help improve the way we care for our COPD patients.

To download a copy of her proposal please click here: NHS East Lancashire Business Case or click through to this section on our website: Axis-Shield – Respiratory.

The template is designed to provide a framework around which logical arguments for your new service can be put forward. It helps to illustrate the current situation, any problems being faced and then the benefits (both clinical and financial) of developing the new service.

To download a copy of the template please click here: i-STAT Business Case Template or visit the section on our website: Axis-Shield UK – Respiratory

To download the calculator and see how much you could save, just click here: http://www.axis-shielduk.com/uploads/docs/COPD%20costs%202009-10.xls

With the purchase of 133 pulse oximeters from diagnostic company, Axis-Shield UK, Cambridgeshire PCT will have the ability to detect changes in a patient’s oxygen saturation, enabling them to identify problems before the patient is put at risk.

HuntsComm, a practice based commissioning board based in Huntingdonshire, was able to purchase these pulse oximeters as a result of a successful business case submitted to Cambridgeshire PCT.  The success of this case resulted from the proposed use of the pulse oximeters to reduce emergency admissions and provide a higher quality of domiciliary patient care.

Dr Paula Newton, GP at Papworth Surgery, said: “As a member of the HuntsComm Board and a local GP I was delighted that we were successful in this business case. Low oxygen levels in the blood can be fatal and is difficult to detect on clinical examination alone. Using a pulse oximeter can help clinicians to decide whether an emergency admission and oxygen treatment is needed. Recently I used a pulse oximeter in a rare situation where a patient with a wasp sting on their tongue was in respiratory difficulty and needed urgent treatment. The oximeter helped us all to stay calm as we were confident the oxygen levels were staying at a safe level whilst we were resuscitating the patient and waiting for the ambulance.”

Continuing she said: “An average admission with COPD (Chronic Obstructive Pulmonary Disease) costs the NHS £3,000 and there is a higher risk of morbidity and mortality when patients are inpatients compared to being cared for in a community setting. In patients with chronic respiratory conditions, such as COPD, the monitoring of these conditions is made much simpler and more accurate by regular use of pulse oximetry. The provision of these devices has enabled practices to place one in every consulting room and they can also be easily transported to patients’ homes when visits are required. We can now use them routinely in our consultations on a daily basis and have received considerable positive feedback from practices using them.”

Pulse oximeters give an idea of a patient’s cardio-respiratory status by measuring the arterial oxygen saturation of haemoglobin. They use non-invasive selected wavelengths of light to determine this, with no need to actually take a sample of blood from a patient. There are many illnesses that can cause the symptoms of breathlessness, including; asthma, heart failure, lung disease, COPD and some forms of cancer. 

For further information about Axis-Shield UK products please visit www.axis-shielduk.com

Up until the first of February 2006 in England and Wales home oxygen could only be prescribed by primary care physicians. Unfortunately a lot of patients were prescribed oxygen for relief of symptoms of breathlessness without ever having had a formal oxygen assessment. Much of this oxygen was given in the form of cylinders for PRN usage (short burst oxygen therapy – SBOT) a costly provision without good evidence of efficacy of this treatment.

Historically patients within this locality requiring Long Term Oxygen Therapy (LTOT) were assessed within the acute Trust. These oxygen assessments were traditionally based upon availability of ward based beds or occasionally clinic based assessments. These assessment services were not funded as a separate service proving to be spasmodic and unstructured with poor or no follow up monitoring. In addition there is no formal ambulatory oxygen service within this locality which has proven to be a costly and growing service with portable oxygen cylinders supplied to patients as a “want” rather than “need” service.

The implementation of the new oxygen contract has highlighted that appropriate assessment is essential so that patients are treated with home oxygen for the right period of time and with appropriate flow rates to obtain optimal benefits and reduce chances of adverse events.

An attempt to rationalise oxygen prescribing by reviewing oxygen assessments at home was explored within NHS Hull by introducing the i-STAT portable gas analyser for home based blood gas assessments, monitoring and treating patients at the point of care.

The hand held i-STAT enables respiratory nurses to monitor the status of respiratory patients within minutes when conducting home visits. This means informed decisions on accurate oxygen prescribing and the need to prevent hospital admission to undergo further assessment. It also means less anxiety and inconvenience for patients, who can find out test results on the spot.

Using advanced biosensor technology and as little as two drops of capillary blood from the ear can deliver accurate testing for blood gases.

To read the rest of the report, please click here.

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common respiratory conditions of adults in the developed world. Encompassing chronic bronchitis and emphysema, this debilitating condition affects approximately 1.4 per cent of the UK population and is the country’s fifth biggest killer.

While many COPD sufferers are kept under close surveillance, some unfortunately still remain at high risk of emergency admissions – which can be costly to Primary Care Trusts (PCTs) from both a financial and a patient care perspective.

With the number of COPD case loads expected to rise over the coming years, improving the level of care for patients, avoiding related emergency admissions and keeping costs under control, are all high priorities – something the team at Central Surrey Health realised several years ago. Julie Ricketts, Lead Nurse at Leatherhead Community Assessment Unit which is operated by Central Surrey Health, takes up the story and reveals there are some very real benefits to be gained from testing and treating patients in the community.

“In November 2005, the team at the Leatherhead Community assessment unit were tasked with moving their services into the community. Previously we had worked out of the acute hospital, testing patients, putting them forward for referrals internally, or providing treatment as appropriate. While we were generally considered to be functioning well, government targets and the change from trolleys to beds meant our unit ceased to function as a full assessment unit. The decision was made to move us into the community to support patients at a primary care level and help prevent emergency admissions.

“The service was initially quite tricky to set up – we didn’t have long to get going. We needed to work closely with GP surgeries and our colleagues to educate them about what was on offer and, in the first instance, we were only given funding for three months.

“However, we worked hard and patients started coming to the unit from their local GP, as well as the acute trust and the ambulance service. It quickly became apparent we were going to become a more permanent community fixture.

“At the start of the service we saw approximately 90 patients each month with a wide variety of conditions. Some had suspected heart failure, were new patients with atrial fibrillations or were suffering with cellulitis and deep vein thrombosis. Others needed testing and treatment for chest infections, asthma and COPD. There was however one piece of common ground. If these patients hadn’t come to our unit, they would have ended up at the local A&E department. There they would probably have had a series of tests, before being admitted to a bed for a potentially lengthy period while samples were sent for analysis at the hospital laboratory.

“As our initial period of funding came to an end, we used the national tariff for emergency admissions to calculate how much money we were saving the local trust. The figures were startling and totalled between £25,000 and £30,000 each month.

“Suffice to say our funding continued and by the end of our first year we had saved £600,000 net. Today, just three years on, we see in excess of 250 patients a month that would have been sent straight to the acute hospital – not bad numbers for an assessment team of just four people who cover a catchment area with a population of more than 280,000.

“So how has such a small team managed to work so effectively? Well, from the start we knew we needed to differentiate our service by employing equipment that would enable us to give patients their test results quickly. With our main emphasis being on quality patient care, we wanted to make informed decisions within a matter of minutes about the kind of treatment required to get patients back home, or on to the hospital for further assessment if required.

One of the first pieces of equipment we purchased was the i-STAT; a unique handheld analyser from Axis-Shield UK. We use this device to perform a range of tests including oxygen trials on patients with COPD who are at high risk of emergency admission. Prior to our set up, patients needing these tests would have been seen as day cases in the local hospital and would have had to wait around for their results. We work very closely with our respiratory team and are now able to perform these tests and give patients their results quickly.

Using devices like i-STAT has improved our patient management, helped cut result times and made for a relaxed atmosphere, which is very different from the typical hospital environment.
Patients like the service we offer and cannot believe how quickly we can obtain their results. Patients needing oxygen trials or infusions are made comfortable for a slightly longer visit but our average turnaround time for assessment is now just 24 minutes – a number which really does speak for itself.

Looking ahead, now people know about our unit and what can be achieved in the community, we are keen to further develop our patient services. We are working closely with local GPs and other health care professionals to find out how they would like us to expand our services. We are also working with other care trusts to provide consultancy and help set up other similar units in different regions around the country.
The Medical Assessment Unit at Leatherhead Community Hospital is open Monday to Friday from 9am to 6pm. It is operated by Central Surrey Health – a not for profit, limited liability company owned by and employing local therapists and nurses. For more information please contact: Sam Scarrott on 020 8394 3840 or alternatively visit: www.centralsurreyhealth.nhs.uk
For more information about i-STAT from Axis-Shield UK please visit www.axis-shielduk.com or alternatively contact Sue Younghusband on 01480 862100.

COPD is one of the nation’s most prolific diseases. Encompassing conditions like chronic bronchitis and emphysema, this debilitating condition affects approximately 1.5 per cent of the UK population. While many COPD sufferers are kept under close surveillance by the healthcare practitioners around them, many still remain at high risk of emergency admission to hospital – which can be costly to the NHS.

Every time a COPD patient is admitted unexpectedly to hospital, the associated financial impact is £2,337 and in 2003/4 the total cost to the NHS reached a staggering £253 million. As part of its ongoing work with a number of Primary Care Trusts (PCTs), Axis Shield UK has calculated that if each of the 152 healthcare trusts in the UK were to prevent just two emergency admissions a month, the overall cost saving would be £8,525,376.

Commenting, Sue Younghusband, marketing director for Axis Shield UK said: “Reducing COPD-related emergency admissions is now a major priority for the NHS and at the end of this year, the Department for Health will unveil its National Services Framework for COPD – an initiative designed to improve the quality of COPD services the length and breadth of the country. The External Reference Group (ERG) working on this project has already recognised the vital role innovative technologies will play in delivering improved quality of care and patient monitoring for COPD sufferers; something many forward thinking PCTs have also started to recognise.”

Continuing she said: “Our work with a number of respiratory clinics, operating at a primary care level, shows demand is already on the up for portable diagnostic devices like our handheld solution, i-STAT®. Measuring a range of parameters including blood gases and providing reliable, lab accurate test results in minutes, i-STAT® enables respiratory nurses to monitor the status of COPD patients while they are with them. This means informed decisions on accurate dosing, alterations to medication or the need for a patient to undergo further assessment can be made at the point of care. The benefits of this are twofold; less anxiety and inconvenience for patients, who can find out test results on the spot, plus reduced costs for PCTs if emergency admissions are prevented.”

More than 30 PCTs are now using i-STAT® from Axis Shield UK, which has the capacity to store up to 5,000 patient records. The device works by using advanced biosensor technology and as little as two drops of blood plus a test cartridge.