1. Claire Birnie Co Authors: E Reid & C Cameron Department of Clinical Biochemistry Aberdeen Royal Infirmary

2.  Point of Care Clinical Chemistry Analyser ◦ Compact, portable and fully automated ◦ Roughly the size of a shoe box  Ability to test up to 31 different analytes ◦ Specifically designed single use reagent discs  MetLyte Plus CRP  Centrifugal and capillary forces mix samples and reagents ◦ Spectrophotometry  9 wavelengths ◦ Intelligent Quality Control (iQC)

3.  Easy to Use  Small sample requirements  Results in 10-12 minutes ◦ Clinical decisions can be made quickly ◦ “Hard copy” report, transferred to a computer or an LIS.

4.  Current Issue ◦ Hampered clinical decision making ◦ Early specimen collection times ◦ A&E pressures  Staffing, 4 hour turnaround, limited funding  Compare results of Piccolo Xpress™ to routine laboratory methods.  Determine Piccolo Xpress™ success within a community hospital setting

5.  Measured 9 analytes on Advia 2400 & Piccolo. ◦ Na +, K +, Cl -, HCO 3 -, urea, creatinine, creatine kinase (CK), glucose and C- reactive protein (CRP).  8 quality control samples.  20 patient samples.  Total precision and linearity were evaluated using analysis of variance (ANOVA)

6.  IQC was within range and showed strong precision.  Patient results comparable  CK, HCO 3 and CRP are exceptions.  Total CK ◦ Significant positive bias on Piccolo ◦ Results out with normal reference range ◦ Pathological process occurring  Bicarbonate ◦ Needs to be processed within 1 hour  C- Reactive Protein ◦ <200mg/l were comparable ◦ >200mg/l flagged an error on Piccolo

7.  3 month trial in Chalmers Hospital, Banff  17 patients samples analysed ◦ 13/17 patients had management adapted ◦ 10/17 cases reassured clinicians that patients could be treated locally. ◦ 2 patients admissions were expedited to ARI urgently. ◦ 5/17 cases avoided unnecessary admission to A&E.

8. Results available on the same day! Managed on ward Prevented any delay in appropriate management for patient Measuring biochemistry helped rule out more serious illness Very useful to be able to test this patient on a Friday afternoon Alleviated my concern regarding my patients renal function Simple, quick and easy to use.

9.  Ambulance call out and A&E attendance costs approximately £350.  Chalmers Hospital case ◦ 5 admissions prevented in 3 months (approx 20 in a year) ◦ Savings of ~£7000.  Savings of £98000 per year in NHS Grampian ◦ 14 community hospitals ◦ Figures extrapolated from data at one hospital ◦ Limited resources

10.  Emotional Impact ◦ Older patients remaining in familiar surroundings ◦ Stress of ambulance trip ◦ Relatives close by ◦ Large geographical area  A&E pressures ◦ ~400 patients per year not attending A&E  Better utilisation of emergency care services  Bypassing A&E to specialised wards  Maintaining/improving quality and safety of patient care.

11.  Piccolo results were comparable to the routine laboratory method  Improved patient care in a community setting  Reduced admissions to A&E  Urgent referrals to specialised wards.

12.  Abaxis Inc. (2012). Centrifugation Whitepaper. Available: http://www.piccoloxpress.com/wp-content/uploads/888-3027- Centrifugation-Whitepaper.pdf. Last accessed 18th September 2015 http://www.piccoloxpress.com/wp-content/uploads/888-3027- Centrifugation-Whitepaper.pdf  Abaxis Inc. (2012). IQC Whitepaper. Available: http://www.piccoloxpress.com/wp-content/uploads/888-9659-IQC- Whitepaper.pdf. Last accessed 18th September 2015  Abaxis Inc. (2007). Piccolo Xpress Chemistry Analyzer Operators Manual. Available: http://www.poct.co.uk/File/Healthcare_Professionals_User_Area/Piccolo _xpress/1100-7008-1_Rev_C_Xpress_Operators_Manual_Text_- _English.pdf. Last accessed 10th September 2015.  Audit Scotland, (2014). Accident and Emergency Performance Update. [PDF]. Available from: http://www.audit- scotland.gov.uk/docs/health/2014/nr_140508_ae_update.pdf. Last accessed 19th Sept 2015http://www.audit- scotland.gov.uk/docs/health/2014/nr_140508_ae_update.pdf

13. Thank you for listening. Any Questions?