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Establishing an ambulatory care service using point-of-care testing diagnostics.

The use of ambulatory emergency care services in the NHS has been shown to reduce the emergency inpatient burden and enhance the overall patient experience, while demonstrating a cost saving to the NHS. At the James Paget University Hospital point-of-care testing was used as an enabler within an evidence-based lean service redesign to successfully set up a novel unit. A 3-month pilot period, with limited operational times, showed a dramatic improvement in patient flow through the acute medicine pathway, with an equivalent of 59 bed days saved during the pilot period. Further expansion of the unit to a dedicated area with full 7-day opening allowed a continued improvement in performance. This resulted in a mean length of stay of 115 minutes (a 54% reduction from pre-baseline), and just 6.1% of an average of 18.1 daily attendances were converted to full admission. This demonstrated a clinical, operational and financial benefit, allowing improved clinical outcomes.