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Point-of-Care Testing across

rural and remote emergency departments

in Australia: Staff perceptions of

operational impactDahm, M.R.a,, McCaughey, E.a,b, Li, L. a, Westbrook, J. a, Mumford, V. a, Iles-Mann, J.c, Sargeant, A.d and Georgiou, A.a

a Centre for Health Systems And Safety Research, Australian Institute of Health Innovation, Macquarie University.b Neuroscience Research Australia.c Pathology West, NSW Pathology.d Point of Care Testing Services, NSW Pathology.

@MariaDahm @AGeorgiouMQ

HIC 2017, 6-9 August 2017, Brisbane.

Centre for Health Systems and

Safety Research

• Medication Safety and e-Health

• Communication and Work Innovation

• Human Factors & eHealth

• Diagnostic Informatics

• Safety & Integration of Aged and Community Care

Services

• Primary Care Safety and eHealth

Rese

arc

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ods

Develo

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Point of Care Testing (PoCT)

“Tests performed near patients and outside a traditional pathology laboratory” Nichols (2013)

Test turnaround time Lee-Lewandowski & Lewandowski (2010)

Expedited clinical decision making Rooney & Schilling (2010)

Patient & clinician satisfaction Shepard (2013); Blattner et al. (2010)

Test accuracy/ QC/ QA Rooney & Schilling (2010)

Workload & responsibilities Blattner et al. (2010)

Training Rooney & Schilling (2010), Jones et al. (2013)

Operational context Lee-Lewandowski & Lewandowski (2010); St. John (2010)

Quantitative evidence Storrow et al. (2009); Blattner et al. (2010)

AUSTRALIAN INSTITUTE OF HEALTH INNOVATION

FACULTY OF MEDICINE AND HEALTH SCIENCES

Rural and remote NSW



NSW Health Pathology Managed PoCT service implementation

• 300 devices

• 5,000 operators

• 150 rural/remote ED

• External quality assurance program NSW Health Pathology (2015)

Gain a context-rich understanding from frontline clinical staff of the operational impact of the rollout of PoCT across rural and remote EDs in NSW.



Methods – Qualitative study

Ethics Approval: Greater Western Area Health Service Human Research Ethics Committee (Project No. LNR/15/GWAHS/26).

Purposive and diverse sample



Sample/ Site Site A Site B Site C Site D

Staff Interviewed, n 3 6 2 3

ED presentation per month

>500 (high)

>500 (high)

<200 (low)

<200 (low)

PoCT usage (% of presentations)

<12 % (low)

>25% (high)

<12 % (low)

>25% (high)

Methods – Qualitative study

Semi-structured interviews & focus groups

Reiterative thematic and content analysis

NVivo 10 Qualitative coding software Strauss & Corbin (2014);

Patton (2015)AUSTRALIAN INSTITUTE OF HEALTH INNOVATION


• Can you describe how Point of Care Testing has affected your work process?

• Can you tell me how Point of Care Testing has impacted your patients?

• Please describe any positive or negative experiences you have had when using Point of Care Testing.

• Are there any situations where you would prefer to use traditional, laboratory based, pathology over Point of Care Testing?

• In your opinion, what have been the consequences of the introduction of Point of Care Testing?

• Where do you see the future of pathology testing going?

Findings

Five overarching emerging themes

Enhanced Practice



I had an acute infarct come in and it was basically Troponin done, all her other - Chem-8 the CG4 were done. [Before PoCT] we would have only had to go on an ECG [and she] would have been going to [Regional Referral Hospital] first, without going straight to the Cath lab because they wouldn’t have had any baseline blood testing to be done. [… now with PoCT] she was stented two and half hours later. [G]reat outcome, she's now walking around in the community.’ Registered Nurse (RN) – B

Patient Outcomes• Improved test turnaround times, treatment onset

• More efficient and effective treatment

Enhanced Practice

• Increased confidence among Nursing Staff

• Appropriate evidence based treatment

• Better integrated care

• Reduction in unnecessary transfers



‘Well it certainly gives you more information to be able to provide to [regional referral hospital].’ RN - C

Clinical Practice, Governance & Cost

Certainly we're not transferring people out for just simply because they need a blood test and we had been doing that prior. [T]here was ambulance costs or patient transport costs’ HSM –B

Innovative/ disruptive potential

• Overordering of PoCT

• Lack of training for results interpretation

• Increased responsibilities for Nursing Staff



‘If the doctor wasn't in town we wouldn't be doing [a PoCTtest], we'd be transferring them out, RN - D

Patient Outcome and Clinical Practice

‘And it's also put a bit of pressure on us as far as your skills for analysingpathology. […] You've got to really then read up on more and understand what [the results] means ’ RN - B

Innovative/ disruptive potential

• Initial low confidence in PoCT accuracy

• Time-intensive QC/QA

• Increased workload

• Unmet need for dedicatedstaff resources



‘Like, for example, if you see a potassium of 8 on our point of care, […] you should wait for the formal [test results] one to come back, then you start treating your patient..’ Career Medical Officer - A

Pathology, Governance & Cost

There's also the cost of the people - like, me doing the QAP because I'm one of the more expensive people to be paying […] ’ Nurse Unit Manager (NUM) - B

Implications

• New evidence of international relevance

• Contribute to accurate and contextualisedevidence base of impact of managed PoCTservices in rural and remote EDs.

• Need for additional staff training beyond the use of PoCT devices

• Further research required to inform strategies for future implementation in similar settings

• Qualitative approaches are well suited in evaluation of heath information technology in unique contexts

• Need for additional staff resources to cover increased workloads.

Thank youEmail: [email protected]

Twitter: @MariaDahm

This research was undertaken with funding from an NSW Health Pathology.

mailto:[email protected]

References

16

• Blattner, Katharina, Garry Nixon, Chrystal Jaye, and Susan Dovey. (2010). Introducing point-of-care testing into a rural hospital setting: thematic analysis of interviews with providers. J Prim Health Care 2 (1):54-60.

• Corbin, J. & Strauss, A. 2014. Basics of qualitative research (4th ed.). Los Angeles: Sage.

• Jones, C. H. D., J. Howick, N. W. Roberts, C. P. Price, C. Heneghan, A. Plüddemann, and M. Thompson. (2013). Primary care clinicians' attitudes towards point-of-care blood testing: A systematic review of qualitative studies. BMC Family Practice 14. doi:10.1186/1471-2296-14-117.

• Lee-Lewandrowski, E., & Lewandrowski, K. (2010). Point-of-care testing in the Emergency Department. In C. Price, A. St John, & L. L. Kricka (Eds.), Point-of-Care Testing: Needs, Opportunity and Innovation (3rd ed., pp. 397-410). Washington, DC: AACC Press.

• Nichols, J. H. (2013). Point-of-care testing. In D. Wild (Ed.), The Immunoassay Handbook: Theory and applications of ligand binding, ELISA and related techniques (4th ed., pp. 455-463). Oxford, UK: Elsevier



References

17

• NSW Health Pathology. (2015). Point of care testing. Retrieved from http://www.pathology.health.nsw.gov.au/key-projects/point-of-care-testing

• Patton, M. Q. (2014). Qualitative evaluation and research methods. Integrating Theory and Practice (4th ed.). SAGE Publications.

• Rooney, K. D., & Schilling, U. M. (2014). Point-of-care testing in the overcrowded emergency department - Can it make a difference? Critical Care, 18(1).

• Shephard, M. (2013). Point-of-Care testing in Australia: The status, practical advantages, and benefits of community resiliency. Point of Care, 12(1), 41-45.

• St John, A. (2010). The Evidence to Support Point-of-Care Testing. The Clinical Biochemist. Reviews / Australian Association Of Clinical Biochemists, 31(3), 111-119.

• Storrow, A. B., Lyon, J. A., Porter, M. W., Zhou, C., Han, J. H., & Lindsell, C. J. (2009). A systematic review of emergency department point-of-care cardiac markers and efficiency measures. Point of Care, 8(3), 121-125.



http://www.pathology.health.nsw.gov.au/key-projects/point-of-care-testing

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