DRIVE-THROUGH PHLEBOTOMY-DOES IT WORK for CDMARDS MONITORING?

ABSTRACT

Background: Centralised phlebotomy services have been an integral part of providing blood monitoring facility for people with chronic diseases prescribed vital therapies. However the patient experience is not always optimal due to the issues of congestion, parking, long waiting times and have been accentuated during COVID-19 pandemic with the need for minimising physical contact. Expert panels have advocated for the creation of innovative approaches to provide safe patient care while maintaining precautions against COVID-19 spread. Several groups have published the concept and experience of using a drive-through clinic for anticoagulation monitoring and management. There is limited data on how this model of care can impact other clinical services such as rheumatology where patient groups are more vulnerable. Objectives: In response to the growing pressure on phlebotomy service at our institution enhanced by COVID-19 pandemic, our rheumatology service implemented a drive-through phlebotomy clinic to provide the option for patients and families to stay in their vehicles whilst having venepuncture. The objectives were to evaluate the feasibility and patient experience of the service. Methods: At our large university teaching hospital, we set up a drive-through phlebotomy service provided by a senior health care assistant supervised by the lead nurse. It was located near the hospital entrance where vehicles could park for a few minutes without disrupting traffic fow. Patients were identifed from the departmental database and were offered the facility via telephone. Eligibility was assessed using a standardised proforma focusing on logistics such as ability to drive and access to a mobile phone. Appointments were scheduled in advance with patients choosing this care option. On the day, patients were screened for COVID-19-related symptoms before their appointment and were encouraged to stay in their vehicles wearing a mask before being approached by the HCA. At the end of clinic, all samples were submitted to the central laboratory. All the data was prospectively collated with patients' consent and anonymised for analysis. In addition to demographics, diagnosis and drug record, duration of visit and patient feedback was collected. Results: 112 patients were offered the service during a 12-week pilot. Mean age of the participants was 49.5 yrs (19-91) with 73 (65%) women. 74 (65%) were of Caucasian and 28 (25%) of Asian origin. 94 (84%) had infammatory arthritides and all were prescribed DMARDs and/or bone active agents. 69 (61%) had blood samples taken using this service. Most common reason to decline was an already arranged appointment with standard phlebotomy (n=14, 12.5%). Six (5%) could not be bled due to difficult venepuncture. Mean duration of appointment was 12.5 mins (5-60). 68 (60%) provided feedback with 61 (90%) rating 5/5 and 60 (89%) rating it better than standard phlebotomy. All would like to have the option for future and 67 (98%) were highly likely or likely to recommend the service to family and relatives. Conclusion: To our knowledge, this is the frst study to demonstrate the utility of drive-through phlebotomy for people with rheumatic diseases prescribed DMARDs. Excellent feedback of the participants confrms the need and desire for such innovation in health care. Prior publications have shown the benefts of such clinics in anticoagulation services. Arguably, it's more prudent to have this facility for those where there is no alternative such as point-of-care or home INR monitoring. In post COVID-19 services reconfguration with telemedicine and innovative models of care, this allowed fexibility for our department to develop and establish an alternative process. The availability of drive-through appointments and the close physical proximity to the clinic made it an appealing option for a vulnerable group of patients evidenced by their outstanding experience and feedback. Overall, an HCA-delivered, nurse-supervised drive-through pathway is highly effective, safe and provides an innovative solution to stra ned phlebotomy services.