Nursing stations equipped with i-STAT devices

A nurse can do a blood test and know within two minutes if the patient is having a heart attack.

Six remote Health Canada nursing stations in northwestern Ontario are now equipped with i-STAT handheld blood analyzers, a point of care device that’s revolutionizing emergency services in remote communities.
When a community member complains of chest pains at a nursing station in one of the six Indigenous communities– Sandy Lake, Pikangikum, Mishkeegogamang, Kitchenuhmaykoosib Inninuwug (KI), Eabametoong and Deer Lake – a nurse can do a blood test on the spot and know within two minutes if the patient is having a heart attack.
“It helps to determine if it’s heart related, or if it’s something other than a heart attack,” said Dr. Andrew Affleck, the North West LHIN’s Emergency Department Lead. “It will identify the critically ill much more efficiently and result in timely care.”
A positive test result will trigger a “life or limb” call to Ornge for an immediate transfer out, whereas a negative test result will allow the patient to remain in his or her community under the case of the nurse, or be transferred out the following day on a regularly scheduled flight.
“A positive result makes the transfer out a priority,” said Affleck. “They drop everything to go get that patient. It makes a significant difference.”
Of 58 usages analyzed to date, emergency evacuation was avoided 28 times, according to Dr. Homer Tien, chief medical officer for Ornge.
Another 10 nursing stations in remote northwestern Ontario communities will be equipped with i-STATs by the end of the year and, eventually, the plan is to supply the device to every nursing station in the region.
The $10,000 cost per device is an excellent investment given the cost savings, said Affleck. “In the bigger picture, $10,000 isn’t very much. The cost-benefit ratio is tremendous.”
There are also benefits for patients who, in the absence of an i-STAT test, would be transferred out to Sioux Lookout or Thunder Bay unnecessarily.
“For patients who don’t need to go out, we prevent them from being displaced from their home,” said Tien. “We save a flight that can be used for someone who’s really sick and we reduce unnecessary lengths of stay at the various receiving hospitals.”
While the i-STAT is primarily used to distinguish between heart attacks and chest pains or discomfort attributable to other causes, it can also be used to quickly and efficiently diagnose patients experiencing sepsis, a life-threatening condition involving an infection in the bloodstream.
The i-STAT is such a benefit to the province’s air ambulance service that it has agreed to cover the cost of the replacement cartridges.
According to Tien, the nursing stations reorder the cartridges directly from Ornge, following which they are shipped up to Sioux Lookout and distributed to the nursing stations from there.
One trip that Ornge doesn’t have to make probably covers the cost of the cartridges for an entire year, noted Affleck.
Discussions about the possible use of i-STATs commenced three years ago and a pilot involving three sites – Sandy Lake, Pikangikum and Mishkeegogamang – began in 2016.
It was a true partnership. The North West LHIN played a key co-ordinating role, Health Canada paid for the devices and Ornge stepped up to cover the cost of the cartridges.
Abbott, the manufacturer of the i-STAT, also assisted by developing an online training program given the challenges associated with training a widely distributed workforce of Health Canada nurses using traditional face-to-face engagement.
The i-STAT isn’t new technology, said Affleck. “It has been around for at least 15 years, but the technology has really improved and is a lot more accurate. It really is amazing technology. Some emergency departments are even using them for more timely care because you can get readings right away rather than having to wait 45 minutes to get them from the lab.”

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