Introducing point-of-care testing into a rural hospital setting: thematic analysis of interviews with providers

Abstract

INTRODUCTION: Hauora Hokianga Enterprises Trust, an integrated Primary Health Organisation (PHO), which provides primary and intermediate/secondary care to a remote rural community, introduced point-of-care (POC) testing at Rawene Hospital in June 2008. Previously, all laboratory tests were undertaken in Whangarei, with a one to three day turn-around for results. This study aimed to identify the perceived impact of POC testing on clinicians and the community. METHOD: Face-to-face interviews were conducted with 13 health professionals working at Rawene Hospital. The qualitative data analysis computer programme Atlas.ti v5.2 was used to assist the thematic analysis. FINDINGS: Three overall themes captured the main issues with introducing POC testing: (1) POC testing increased clinicians’ confidence, certainty and assurance in their daily practice; (2) POC testing improved diagnostic certainty and this impacted on patients and their families/whanau; (3) the challenges associated with POC testing included increased workload, pressure to up-skill, over-testing, and continuing professional education gaps. CONCLUSION: POC testing is an invaluable technological adjunct for improving clinical decisions and culturally safe care provided to a remote rural community, but it brings challenges to care providers in managing higher workloads and pressures to up-skill. POC testing can improve the acute medical care (access and quality) provided to an economically-deprived, predominantly Maori, rural community. KEYWORDS: Hospitals, rural; point-of-care systems; rural health

Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

“…Community hospitals provide a wide range of services, covering the whole spectrum of care provision, from preventative [2021] and primary care [2223], through to outpatient services [242526], inpatient medical care [2728], surgery [2930], minor injury [31] and accident and emergency care [2232]. Within these broad areas, there was considerable diversity of the types of services provided, and a number of studies further reported on the implementation of new and innovative types and methods of service provision not previously available within the community hospital setting, such as point-of-care testing [23], fracture clinics [33] or chemotherapy [34].…”

“…Within these broad areas, there was considerable diversity of the types of services provided, and a number of studies further reported on the implementation of new and innovative types and methods of service provision not previously available within the community hospital setting, such as point-of-care testing [23], fracture clinics [33] or chemotherapy [34]. …”

“…For example, a survey of NZ rural hospitals reported that 14% of hospitals had a GP on-site at all times and 41% had a facility for the GP to spend the night in the hospital [35], while a study of the ten community hospitals of the Powys region in Wales noted that none of these had resident medical doctors, including GPs [57]. Elsewhere, studies reported on-site availability of GPs only during weekdays, such as in a 12-bed intermediate care hospital in Norway [45], however, GPs are generally available to provide care at night and during week-ends, with on-call GPs committed to provide out-of-hours cover [23576061]. …”

Changes in clinical practice and patient disposition following the introduction of point-of-care testing in a rural hospital

“…An analysis of intangible benefits has been reported separately [5] and includes: clinicians being able to appropriately assess and provide patient care without moving patients unnecessarily-thereby reducing stress and costs on patients and families; improved access to appropriate care for an isolated and high needs Maori community; improved job satisfaction for clinicians; improved communication and integration of patient care between hospitals.…”

“…A qualitative study, reported elsewhere [5], examined in-depth understanding of the effects of the introduction of POC testing on clinicians and the community. The present paper reports analyses of quantitative data collected to measure changes in clinical decisions (diagnostic certainty and patient management including decisions around admission, discharge and inter-hospital transfer) associated with POC test use.…”