Point of Care Clinical Chemistry in A&E

The Emergency Department at Newham University Hospital NHS Trust is leading the way in point-of-care testing (POCT) by placing a clinical chemistry analyser within its own ‘hot lab’, fully supported by the Trust’s Pathology Department. This, in conjunction with other POCT technology, is helping the Emergency Medicine team attain and maintain 98% achievement of the four hour emergency treatment standard. The Trust has achieved this by installing an ABX Pentra 400 analyser from HORIBA ABX which meets the Trust’s needs for an extremely easy to use, compact, reliable and accurate POC clinical chemistry system.

The ABX Pentra 400 provides ‘stat’ chemistry screening results for sodium, potassium, urea and glucose, as well as key add-on tests such as amylase and creatinine. “Having essential patient data immediately to hand gives my colleagues and I more thinking time, enabling us to make faster and better informed decisions on patients’ care pathways. This is undeniably far better for patient outcomes whilst also reducing our turnaround times,” explained Dr Phil Moss, Clinical Lead Consultant for Emergency Medicine.

Following a rigorous tender and in situ trial process, including a financial review investigating whole life costs, the ABX Pentra 400 clinical chemistry analyser emerged as the POC system of choice, meeting all the Trust’s exacting specifications. Natalie Firminger, Emergency Medicine Business Manager added, “In the trials we were not only assessing the reliability of the instrumentation for 24/7 operation, but also that of the supplying companies and their personnel. Excellence in customer support and problem solving is crucial for our Department to ensure that we have near 100% up time.”

Chris Young, Integrated Governance Manager (Diagnostics and Capacity), detailed the complexities involved in installing a POC clinical chemistry analyser, explaining why Newham is one of the first to do so, “Clinical chemistry is notoriously difficult to transfer out of the laboratory due to the complexity of the assays involved and the possibility of instrumentation failure due to a lack of proper competency training, maintenance and quality control procedures. Also, if a system is to be operated by anyone other than a fully qualified Biomedical Scientist, then it must be exceptionally user friendly.”

“The simplicity of the ABX Pentra 400 and its accompanying protocols is crucial since it is operated outside of the laboratory by Health Care Assistants,” said Visha Patel, Biomedical Scientist responsible for POCT for this project. “Blood sample tubes are barcode labelled and centrifuged prior to being placed directly onto the analyser when a green light indicates it is OK to do so.” By reading the sample tube barcode the ABX Pentra 400 knows exactly which tests are required as it interfaces directly with the hospital EPR system and Pathology LIMS.

Once analysis is completed, sample tubes are removed, placed into bags and sent via an airtube system directly to the laboratory. Barcode labels and IT integration mean no paperwork is required to accompany them, since the laboratory can simply swipe them on arrival for final validation.

The Trust has noted significant financial changes too. “Since the installation of the ABX Pentra 400, we have been able to demonstrate a 50% reduction in monthly running costs for our POC clinical chemistry,” confirmed Natalie Firminger. “The ABX Pentra 400 has certainly met all of our requirements for ease of use, time and cost savings.”