Changes in clinical practice and patient disposition following the introduction of point-of-care testing in a rural hospital.
OBJECTIVE
To determine whether the practical impact of point-of-care (POC) laboratory testing justifies its use in a remote rural hospital.


METHODS
Test indication, pre-test differential diagnosis and planned patient disposition were recorded over 6 months before and after POC test use in Rawene hospital, in New Zealand's remote north. Doctors recorded impacts on patient treatments (no change, some change or a significant change). Comparisons were made using paired t-tests or chi(2) tests. An analysis of cost versus tangible benefits was also undertaken.


RESULTS
269 POC tests were undertaken for 177 patients. POC tests significantly increased diagnostic certainty (2.5 diagnoses pre-test versus 1.3 diagnoses post-test (p<0.001)), and altered disposition for 43% of patients (p<0.001) by reducing transfers to base hospital by 62% (52 pre-test and 20 post-test) and increasing discharges by 480% (7 pre-test and 34 post-test). Substantial treatment change was reported in 75% of cases, some change in 22%, and no change in 3%. Overall financial benefits amounted to $452,360 annually.


CONCLUSIONS
POC testing helps address inequity in acute health care provision for a disadvantaged rural community by allowing rural clinicians access to necessary and critical investigations in a clinically relevant turn-around time.
Blattner
Katharina
K
Hokianga Health Enterprise Trust and Department of General Practice, Dunedin School of Medicine, Kaikohe, New Zealand. katharinablattner@xtra.co.nz
Nixon
Garry
G
Dovey
Susan
S
Jaye
Chrystal
C
Wigglesworth
John
J
D016009:Chi-Square Distribution; D003363:Cost Control; D003937:Diagnosis, Differential; D006780:Hospitals, Rural / Q000191:economics*; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000191:economics; D019095:Point-of-Care Systems / Q000191:economics*; D010818:Practice Patterns, Physicians'