Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health Point of Care Testing Graeme Thomson, Angliss Hospital
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Graeme Thomson, Angliss Hospital - Point of Care Testing, Not a Simple Solution
Graeme Thomson delivered the presentation at the 2014 Emergency Department Management Conference.
The 2014 Emergency Department Management Conference explored areas such as how to improve access to care, clinical redesign, NEAT compliance, patient flow, point of care testing, geriatric care, and enhance the performance of Emergency Department.
For more information about the event, please visit: http://bit.ly/edmanagement14
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Transcript
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Point of Care Testing
Graeme Thomson, Angliss Hospital
A Case Study
How to lose a year of your life but come out
smiling.
What is POC testing?
• Test processing at/near the patient
• Present in some form for many years
– glucometers, urine dipsticks
Why use POC?
• Rapid results
• Early clinical decision-making
• Early interventions
• Reduced test usage by limiting options
• Improved clinical outcomes
• Improved NEAT performance
• No laboratory access
The evidence
• Tests have variable accuracies and utilities
• Commercially funded studies very positive but
selective
• Independent studies have more marginal results
Local evidence
• St George Hospital study
– Some improvement in Time to Decision-Making
– Some reduction in ED LOS for some patient groups
– Possibly reduced costs
– Greater for discharged group seen by senior doctors – The Integrated Point of Care Testing (IPoCT) Project in the ED, Chan A
et al, 2012
Best practice example
• Massachusetts General Hospital
• Comprehensive parent laboratory
• Satellite POC laboratory in ED
• Staffed 24/7 by laboratory technicians
• 10 minutely rounds to collect specimens
• Demonstrated decreased time to result availability
Angliss pre-POC
• Urban district hospital
• Part of Victoria’s second largest health service
• ED with 40,000+ attendances
• Obstetric unit with 2000+ deliveries
• Other general inpatient services
• 24-hour laboratory with rapid turnaround times
• Some microbiology and complex tests sent away
POC introduction
• Limitation of laboratory hours to reduce costs
• No on-site service from early evenings (week)
and early afternoons (weekend)
• POC testing in ED
• Limited POC in Theatre, HDU, SCN
• Non-POC tests sent away or deferred
The big questions
• What POC tests would be available?
• Who would do the testing?
• Who would pay for the tests?
• How would test results be stored?
• Who would maintain the machines?
• How long would non-POC tests take?
The big questions
• Where would the machines be located?
• How would Blood Bank operate?
• What would be the effects on clinical management,