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

ObjectivesTo determine whether the practical impact of point-of-care (POC) laboratory testing justifies its use in a remote rural hospital.MethodsTest 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 χ2 tests. An analysis of cost versus tangible benefits was also undertaken.Results269 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.ConclusionsPOC 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.