The Mobile Laboratory Unit Örebro, Sweden September 28th 2016 Laboratory technician, lecturer Susanne Andresen

How did the idea to the Mobile Laboratory Unit emerge?

• Final diagnose

• 20-25 % Lung Disorders (COPD pneunomi , dyspnea etc.)

• 20-25 % Cardiovascular diseases

• 40-60 % of the remaining diagnoses allow for the prevention of admissions. Statement on the diagnosis of Stroke, Dehydration, Constipation, pneumonia, cystitis, COPD, heart failure, intestinal infection, Fracture.

Age ≥ 67 years

Purpose of the Mobile Laboratory Unit

• The purpose of the mobile laboratory unit is to prevent unnecessary hospitalizations and rehospitalizations of senior citizens in the municipality of Koege.

• When the test results are available after less than 30 minutes, the emergency room nurse will contact the patient’s General Practitioner, the out-of-hours doctor or a doctor in the Emergency Department at Zealand University Hospital Koege to assess whether the patient requires treatment at home or needs to be hospitalized.

”Shared care model”

Diagnoses

• UTIs (urinary tract infections)

• COPD (chronic obstructive lung disease)

• Dizziness

• Dehydration

• Diarrhea

• Constipation

• Infections (pneumonia, erysipelas, pyelonephritis, etc.)

• Terminal patients

• The primary target groups are chronic patients, elderly and frail patients, and possibly terminal ill patients, who can advantageously be treated in their own homes

The Mobile Laboratory Unit

Workflow in the Mobile Laboratory Unit

The requestor calls the nurse in the Mobile Laboratory Unit and gives information about - reason to referral - comorbidity - which observations and tests are needed When everything is ready the Mobile Laboratory Unit visits the patients at their own address. The workflow is at the patients own home.

Triage

• Assessment Report

• Medical Records

• Documentation of

treatment

• Statistics

Responsibility for the receipt of results

• Testresults are automatically transferred via edifact to the General Practitioner, the out-of-hours doctor or a doctor in the Emergency Department. ECGs are faxed to the General Practitioner.

• The nurse gives the General Practitioner or the doctor in the Emergency Department a short report on the phone.

• When the testresults are available the requestor and the doctor in the Emergency Department will together assess whether the patient requires treatment at home or needs to be hospitalized.

• The Mobile Laboratory Unit brings an assortment of drugs for treatment of the most common medical diseases.

From idea to “The Mobile Laboratory Unit”

• Small residential streets < 3500 kg.

• Reversing camera

• Diesel Generator

Starting point

Equipment

• Monitor: BP, pulse, SAT, resp .

• Frequency alcohol meter

• Thermometer

• Bladder Scanning

• Defibrillator

• Port- a'neb (atomizer for bronchiedilating medicine)

• Various medications for oral or iv . infusions

• Blattercatheters, Peripheral vein catheters

• Peak flow meter

• ABL 90

• Clinitek

• Statspin

• ABX Micros-CRP 200

• ABX Pentra 400

• Cobas h232

• Coaguchek

• HemoCue WBC Diff (back up)

• EKG

• 2 PCs

• PTB printer

• Fax

Time spent at the citizen

0

20

40

60

80

100

120

01

-09

-20

15

07

.09

-20

15

08

.09

-20

15

07

.09

-20

15

11

.09

-20

15

16

.09

-20

15

17

.09

-20

15

25

.09

-20

15

30

.09

-20

15

01

.10

-20

15

23

.09

-20

15

24

.09

-20

15

13

.10

-20

15

19

.10

-20

15

20

.10

-20

15

27

.10

-20

15

29

.10

-20

15

02

.11

-20

15

04

.11

-20

15

06

.11

-20

15

11

.11

-20

15

13

.11

-20

15

18

.11

-20

15

26

.11

-20

15

26

.11

-20

15

02

.12

-20

15

04

.12

-15

11

.12

-15

17

.12

-15

18

.12

-15

05

.01

-20

16

11

.01

-20

16

14

.01

-20

16

19

.01

-20

16

22

.01

-20

16

26

.01

-20

16

29

.01

-20

16

02

.02

-20

16

08

.02

-20

16

12

.02

-20

16

22

.02

-20

16

03

.03

-20

16

08

.03

-20

16

15

.03

-20

16

22

.03

-20

16

31

.03

-20

16

01

.04

-20

16

06

.04

-20

16

08

.04

-20

16

13

.04

-20

16

14

.04

-20

16

20

.04

-20

16

25

.04

-20

16

26

.04

-20

16

04

.05

-20

16

min

utt

er

dato

Hospitalization / readmissions after visiting the Mobile Hospital Laboratorium

O = Inpatient same day

7 = Hospitalization within 7 days

N = No admission

0

50

100

150

200

250

0 7 N

anta

l

Review of testresults after Year 1

Orange lines shows the

reference interval

Our experiences • Paradigm shift. The citizens are very happy and thankful – they do not

want to be hospitalized

• The citizens (>80 years of age) ask the GP to send the Mobile Laboratory Unit. They have read about the Mobile Laboratory Unit in the newspaper or seen us visiting the neighbors.

• The GPs are satisfied – the cooperation has improved.

The impact of interdisciplinary cooperation– Anne (nurse)

• Common understanding of the job

• Testresults supports the clinical findings – other findings evolve

• We are proud of what we accomplish together

• In the cab: Common sharing of knowledge

• Respect for different competences

A perfect day.

We want to be on the road! Thank you for your attention.