Discussion on introduction of POCT as a replacement for on call laboratory services

1. Introduction of the iSTAT
analyser at the Vale of Leven
Hospital
Charlie Houston Senior Biomedical Scientist
Inverclyde Royal Hospital
A proposal to save money by the introduction of
further point of care testing

2. Reasons
• NHSGG&C policy paper
“Vision for the Vale “
• A&E closed –replaced my MAU
• Forecast reduction of OOH requests to
1320 requests per annum
• EWTD compliance

3. POCT already available within MAU
• Hemochron INR system
• IL Gem ABG analyser
• Clearview pregnancy testing kits
• Abbott Xceed blood glucose analyser.
• NO POCT solution for U&E

4. Gap analysis
• Gap analysis POCT solution for U&E
• Using iSTAT Chem 8 Cartridges
– Electrolytes
– Glucose
– Urea
– Creatinine
– Calcium

5. Options -1
• Stay with current OOH laboratory system
– Strengths
• Easy!
• Known costs
• Low risk
– Weakness
• Fails to meet current or future expectations from "Vision for
the Vale”
• Expensive
• Not EWTD complaint -Unlawful

6. Options -2
• Perform U&E on i-STAT
– Strengths
• Proven pathway
• True point of care technology
• Highly Portable
• Secure, robust results
• Enables service flexibility
– Weaknesses
• Investment and revenue costs - iSTAT instrument , Staff
Training
• Lack of support/opposition from staff-more work for nursing staff

7. Options -3
• Await Urea/Creatinine assay for Il Gem ABG
– Strength
• Users already experienced with this
• When cartridges introduced only increase will be in Revenue
costs
– Weakness
• Don’t know when available - untried

8. Costs
Capital
• i-Stat Analyzer x1 package ( includes printer,
rechargeable battery, downloader/recharger,
electronic simulator and training) £8,356.00
Revenue
• ISTAT Chem8 Cartridges (Box of 25) @ £150.00
approx pr box 25 Total pr year approx £7950.00
• Level 1 and 3 Control @ £13.00 each £130.00
Training
• Training for the use of iSTAT analyser will be
provided by the medical instrument company .

9. Benefits & Risks
• Benefits:
– Significant cost benefits
– Laboratory staff will work EWTD compliant hours
– Rapid therapeutic turnaround out of hours
• Risks: Possible risks
– Lower income for laboratory staff leading to job dissatisfaction
(possible pay protection or performing OOH work at Royal
Alexander Hospital)
– Slow implementation due to training issues (availability of
staff)
– New service availability inevitably simulates its own increase
demand

10. Will we save money?
Investment Appraisal / Costs: Benefits Analysis:
Currently out of hours call
£44,000 per annum
out @ £25.00 on possible
1760 U&E =
First year costs Capital
£8,356.00 + revenue
£16,306 in 1st year
£7950.00 on possible 1760
U&E =
NET saving in first year £27,694