Does Point-of-Care Testing Impact Length of Stay in Emergency Departments (EDs)?: A Before and After Study of 26 Rural and Remote EDs.

The implementation of Point-of-Care Testing (PoCT) services across rural and remote emergency departments (EDs) by NSW Health Pathology has the potential to significantly improve timely access to results for certain types of pathology laboratory tests and help to deliver timely patient care. The aim of this study was to examine the impact of the implementation of PoCT on the length of stay (LOS) of patients in rural and remote EDs. A total of 3808 patients with a circulatory system illness were treated and discharged at any one of 22 rural and remote EDs during the study period. Generalised Estimating Equation (GEE) modelling was applied to examine whether the implementation of PoCT impacted the ED LOS with adjustment for a range of clinical variables. More patients were treated and discharged from these rural and remote EDs within 4-hours after the PoCT implementation (post-PoCT 86.8% versus pre-PoCT 84.3%). Although average ED LOS was 11 minutes shorter in the post-PoCT period, the impact of PoCT on ED LOS was not conclusive after considering other important clinical factors (p=0.07). This study is the one of the few to examine changes in LOS following the introduction of PoCT in EDs in Australia. The study also identified areas where more robust methods could be applied in the future as the quality of PoCT data improves to further assess the potential effects of this technology on practice and outcomes.

Point-of-Care Testing Across Rural and Remote Emergency Departments in Australia: Staff Perceptions of Operational Impact.

New South Wales (NSW) Health Pathology is implementing one of the world's largest managed PoCT services across rural and remote Emergency Departments (EDs) in New South Wales, Australia to improve patient access to care. The aim of this qualitative study was to gain a context-rich understanding of the operational impact of the NSW rollout of PoCT across rural and remote ED settings as experienced by frontline clinical staff. Clinical professionals (n=14) participated in interviews and focus groups in August 2015 at four rural and remote NSW EDs. Participants perceived that PoCT provided greater access to pathology thus facilitating more efficient and effective patient care via faster test turnaround and time to treatment and more effective decisions about the need to transfer patients to appropriate sites when required. These factors have a potentially important role in saving lives. Staff also identified innovative and disruptive challenges to clinical work patterns associated with PoCT implementation, particularly in relation to work flows, resource allocation and the governance arrangements.

Assessing Data Integration and Quality for the Evaluation of Point-of-Care Testing Across Rural and Remote Emergency Departments in Australia.

In Australia, New South Wales Health Pathology's implementation of managed Point-of-Care Testing (PoCT) services across rural and remote emergency departments (EDs) has the potential to significantly improve access to results for certain types of pathology laboratory tests and help to deliver timely patient care. The aim of this study was to assess the quality of the datasets, including the integration of PoCT results into clinical systems, as a precursor to the application of an evaluation framework for monitoring the delivery of PoCT services and their impact on patient care. Three datasets, including laboratory, ED presentations and hospital admissions data were extracted from the relevant clinical information systems. Each dataset was assessed on six dimensions: completeness, uniqueness, timeliness, validity, accuracy, and consistency. Data incompleteness was the largest problem. Assessing the PoCT data integration and data quality is a precondition for the evaluation of PoCT and for monitoring and improving service delivery.