Strategic Point-of-Care Requirements of Hospitals and Public Health for Preparedness in Regions at Risk

Abstract

Objectives To study health resources and point-of-care (POC) testing requirements for urgent, emergency, and disaster care in Phang Nga Province, Thailand; to determine instrument design specifications through a direct needs assessment survey; to describe POC test menus useful in the small-world network; and to assess strategies for preparedness following the 2004 Tsunami. Methods We surveyed medical professionals in community hospitals, a regional hospital, and the Naval Base Hospital; and officials at the offices of Provincial Public Health and Disaster Prevention and Mitigation. Questions covered: a) demographics and test requirements, b) POC needs, c) device design specifications, and d) pathogen detection options. Respondents scored choices. Scores determined priorities. Results Respondents selected complete blood count, electrolytes/chemistry, blood type, oxygen saturation (by pulse oximeter), hematocrit, and microbiology as top priorities, and preferred direct blood sampling with cassettes. Cardiac biomarkers were important in alternate care facilities. Staphylococcus aureus, SARS, Streptococcus pneumoniae, and hepatitis B were top infectious disease problems. Temperature, vibration, humidity, and impact shock were four important environmental conditions during extreme conditions. Conclusions Point-of-care testing can be used on a daily basis for competency and efficiency. Familiarity improves preparedness. Instrument designs must anticipate user preferences and environment stresses. The results show how a region at risk can adapt its small-world network. Point-of-care testing has become an important risk-reducing modality for crises and works equally well in low-resource settings to speed the delivery of routine and urgent care.

Geospatial Hotspots Need Point-of-Care Strategies to Stop Highly Infectious Outbreaks

“…Leptospirosis was diagnosed by PCR, not yet amenable to testing directly at the site of need. Kost 28…”

Geospatial Science and Point-of-Care Testing: Creating Solutions for Population Access, Emergencies, Outbreaks, and Disasters

“…While one account touted successful disaster response at the Takuapa District Hospital slightly north and inland in Phang Nga Province (98), several others more objectively documented broad failure and inadequate preparedness in community hospitals, especially coastal resorts and muubaans (villages) hit by the tsunami (67,68,99,100). For example, the care of critical patients was compromised by lack of blood gas instruments throughout all community hospitals, and at the time, an analyzer that performs blood gases (pO 2 , pCO 2 ), pH, and electrolyte (e.g., K + , Na + , and Ca +2 ) tests simultaneously on whole blood was inoperable in the Takuapa District Hospital, to which hundreds of critically injured tsunami victims were transferred (67,68).…”

Vulnerability of point-of-care test reagents and instruments to environmental stresses: implications for health professionals and developers

“…***p < 0.001, **p < 0.01, *p < 0.05. Adapted from Kost et al [13] with permission of authors and editors.…”

“…In a needs assessment survey of medical professionals related to critical, emergency, and disaster care services, respondents prioritized and emphasized the need for future POC device designs to be protected against temperature, vibration, humidity, and impact shock ( Figure 1) [13].…”

“…[13][14][15][18][19][20][21][22][23][24][25][26][27][28][29] summarizes environmental stress testing studies of POC tests based on a PubMed literature search spanning the period 1990-2013. Louie et al…”