Improving in-home diagnostics by the use of Point Of Care Technology in the acute home care setting; a pilot and feasibility study.

Introduction: In frail, older, multimorbid citizens, timely recognition of disease symptoms is challenging leading to delays in timely treatment initiation, and increased risk of acute hospital admission. Point-of-Care-Technology (POCT), such as Focused Lung Ultrasound Scan (FLUS) and bedside analysis of biological material (blood, oral swab, urine) carried out in the patients home may give clinical support for acute disease.

Currently, acute community nurses (ACNs) working in acute community health care services, mandatory since 2018, are trained in in-home clinical assessment, including simple POCT.

Aims, Objectives, and Method: In a descriptive pilot study, approved by the Scientific Ethical Board, our aim was to see if extended use of POCT and FLUS in a patient’s home is feasible. A FLUS trained physician accompanied an ACN when visiting community-dwelling citizens, aged 65+y, referred to the ACN for an in-home acute health assessment during the study period (September-November 2021). The ACN, independently of the physician, made a clinical assessment and registered a tentative diagnosis. Hereafter, FLUS and bedside biochemical analyses were carried out by the physician and the results were compared to the tentative diagnosis made by the ACN. All clinical information was made available to the primary care physician.

Results: At the time of the abstract submission, 100 consecutive citizens in Kolding municipality, referred to an ACN assessment were visited. No quantitative data analyses have been carried out, but will be ready for the congress. The pilot study shows that it is feasible, and has a low rate of decline from participants. Moreover, it has given valuable insight for the in-home use of enhanced POCT including FLUS, and it is likely that the supplementary clinical information narrows down the tentative diagnoses, and may promote early treatment.

Conclusions: In-home assessment using POCT and FLUS is feasible to use.

Implications for applicability/transferability, sustainability, and limitations: A cluster-RCT with FLUS trained ACNs as the intervention is under preparation. If the results are positive, it is feasible to up-scale to health care systems using community nurses in the prevention of acute admissions.