1. Setting up the analytical panel
ENHANCEMENT OF PAEDIATRIC “HOME CARE” SERVICE BY MEANS OF A MOBILE POCT
Di Maira G., Gaggero D., Marotta F., Gallo C., Ventrella W., Pasquarella E., Casalaro A., Pessina R., Manfredini L.*, Facco F. Department of Translational Research and Laboratory Medicine, * Home care service G. Gaslini Children Hospital - Genoa - Italy
Introduction
In 2009 we planned a Mobile Laboratory for the haemato-oncologic outpatients of the Home Care Service of G. Gaslini Children Hospital.
Targets aimed by this project were: reducing TAT, performing a wide analytical panel (comprehensive of unstable analytes) at patient’s home, assessing micro-methods (sophisticated but easy and ready to use), and validating a modern project of mobile lab that can be used to safely enhance the “at home” medical care up to a semi-intensive level.
Materials and methods
Setting up the analytical panel
Blood cells counter: Menarini Medonic
Dry chemistry: Menarini Spotchem EZ SP 4400 (glucose,creatinine, AST,ALT, tryglicerides, urate, bilirubin, albumin, total protein, lactate dehydrogenase, BUN, HDL cholesterol, Mg, P.
Blood gas analysis + Ions (K, Na, Ca): IRMA Trupoint
CRP: Orion diagnostica Quick Read GO
planning
building
Instrument shock tests
Fitting up
Printing report on board,
Validating results by
a remote supervisor, Sending by to the physician on field
Receiving tubes, testing samples
MoLab close to the patient’s home
The scientific sponsorship of the Italian Society of Laboratory Medicine (SIMeL)
The Team
The Mobile Laboratory (MoLab)
at the first visit the home care team can:
Immediately
decide about home care for intercurrent “low risk” problems
optimize admission’s turnover with other patients
get “special therapies” by subcutaneous access, adjuste hydro-electrolytic balance and parenteral nutrition.
Well in advance (hours):
plan therapies with chemiotherapic and emoderivatives by infusion
Results
2011
2012
2013
n. pts 41
391
634
Opearating days 11
179
156 Km
1700
3361
3421
A complete, thorough check at patient’s home took no more than 15 minutes without any time spent in the pre- and post-
analytical phases
The home care team reduced second intervention for therapy adjustement by 65%
Discussion
Before this project took place, patient blood samples were collected by specialized nurses at the patient’s home and brought to the core laboratory by themselves. Once the results become available the team returned to the patient's home, to apply the correct therapy.
Human and economic resources and a considerable time were wasted before a proper at home patient management.
Moreover, the length of the pre-analytical phase might cause preanalytic artifacts
Patients might undergo unnecessary hospitalization based only on the above factors
Conclusion
The MoLab proved to be an effective and reliable system for performing laboratory analyses at patient’s home; test results can be obtained in a considerably shorter time, with a favourable impact on the efficacy of care. This model could be useful to move inpatients also from high specialty units toward outpatients
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