James Cook University ISSN 1445-6354
Introduction: Hokianga Hospital is a small rural hospital in the far north of New Zealand serving a predominantly Maori population of 6500. The hospital, an integral part of a comprehensive primary health care service, provides 24/7acute in-hospital and emergency care. Point of care biochemistry has been available at the hospital since 2010 but there is no on site laboratory. This study looked at the impact of introducing a point-of-care haematology bench top analyser at Hokianga Hospital.
Methods: This was a mixed methods studyconducted at Hokianga hospital over four months in 2016. Quantitative and qualitative components and a cost benefit analysis were combined using an integrative process. Part I. Doctors working at Hokianga hospital completed a form before and after point-of-care haematology test, recording test indication; differential diagnosis; planned patient disposition; and impact on patient treatment.Part II. Focus group interviews with Hokianga hospital doctors, nurses and cultural advisor. Part III. An analysis of cost versus tangible benefits.
Results: Part I. 97 point-of-care haematology tests were included in the study. 97% of tests were undertaken in the setting of the acute clinical presentation and 72% were performed out of hours. The average number of differential diagnoses reduced from 2.43 pre-test to 1.7 post-test, (chi-square tests p < 0.05). There was a significant reduction in the number of patients transferred and an increase in the number of patients discharged home (chi-square tests p < 0.05). Part II. Three main themes were identified: impact on patient management; challenges; and the commitment to ‘make it work’. Point-of-care haematology had a positive impact on patient management and clinician confidence mainly by increasing diagnostic certainty. The main challenges related to the hidden costs of implementing the analyser and its associated quality assurance program in a remote from laboratory setting. Part III.Tangible cost benefit analysis showed a clear cost saving to the health system as a whole.
Conclusions: This is the first published study evaluating the impact of haematology point-of-care on acute clinical care in a rural hospital with no onsite laboratory.Timely access to a full blood count point of care improves clinical care and addresses inequity. There was anoverall reduction in healthcare costs.The study highlighted the hidden costs of implementing point-of-care systems and their associated quality assurance programs in a remote from laboratory context.