This Speaker Program is sponsored by, and on behalf of, Abbott and the content of this presentation is consistent with all applicable FDA requirements

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

For In Vitro Diagnostic Use Only 1510.REV1

The results shown here are specific to one health care facility and may differ from those achieved by other

institutions.

Disclaimer

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-on-year funding

National Perspective:

•AEC shown to play vital role in decreasing hospital length-of-stay

•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….

Update daily, Avoid deviation, Include issues log and document causes of delay

Project Planning:

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:

•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

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%

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

(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

Intended Use Information

Any questions?

Many thanks for listening

1510.REV1

© Abbott Point of Care Inc. 400 College Road East Princeton, NJ 08540 609-454-9000 609-419-9370 (Fax) www.abbottpointofcare.com

Sponsored by