Sustained Quality and Service Delivery in an Expanding Point-of-Care Testing Network in Remote Australian Primary Health Care

Abstract

Context.— Since 2008, the Northern Territory Point-of-Care Testing Program has improved patient access to pathology testing for acute and chronic disease management for remote health services. Objective.— To evaluate the analytical quality, service delivery, and clinical utility of an expanding remote point-of-care testing network. Design.— Four years (2016–2019) of data on analytical quality, test numbers, and training statistics and 6 months of clinical point-of-care testing data from Abbott i-STATs at remote health services throughout the Northern Territory were analyzed to assess analytical performance, program growth, and clinical utility. Results.— From 2016 to 2019, point-of-care test numbers increased, with chemistry and blood gas testing more than doubling to 8500 and 6000 tests, respectively, troponin I testing almost doubling (to 6000), and international normalized ratio testing plateauing at 8000 tests. Participation in quality control and proficiency testing was high, with quality comparable to laboratory-based analytical goals. A shift toward flexible training and communication modes was noted. An audit of point-of-care test results demonstrated elevated creatinine, associated with chronic kidney disease management, as the most common clinically actionable patient result. Conclusions.— The Northern Territory Point-of-Care Testing Program provides high quality point-of-care testing within remote primary health services for acute and chronic patient management and care. Clinical need, sound analytical performance, flexibility in training provision, and effective support services have facilitated the sustainability of this expanding point-of-care testing model in the remote Northern Territory during the past 11 years.

Pathology Testing at the Point of Patient Care: Transformational Change for Rural Communities

“…The imprecision for QC testing for a representative selection of critical i-STAT analytes-sodium, potassium, creatinine and pH-is shown in Figure 7. The average imprecision across the past 6 years for each analyte was: sodium 0.6%, potassium 1.0%, creatinine 3.5% and pH 0.2%, with each analyte meeting or being close to the imprecision goals currently achieved by participants in the RCPAQAP condensed POC testing program, survey 6, 2022 (of 0.5, 1.0, 4.6 and 0.2%, respectively) [30]. This data highlights the remarkably consistent and analytically sound performance of these tests in the hands of remote area POC testing operators.…”

“…By placing the i-STAT into a downloading cradle, patient and quality test results can be instantaneously transferred to a central data repository. A more detailed and recent review of the NT POCT program has been published elsewhere [30].…”

Patient Self-Testing of Kidney Function at Home, a Prospective Clinical Feasibility Study in Kidney Transplant Recipients

“…Automated quality assurance and blood sample analysis begins immediately after the user inserts the test cartridge into the analyzer, with results displayed on screen within 2 minutes. i-STAT CHEM 8+ cartridges are CE-approved for measuring several blood components, 14 , 15 , 16 including potassium and creatinine.…”

Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care

“…Like the QAAMS program, the NT i-STAT POC testing also has significant longevity, with 13 years of continuous operation and government funding [14]. The sustainability of the NT i-STAT POC testing program is largely associated with the demonstrated economic benefits of POC testing in acute clinical management in remote primary health care, due to averted medical evacuations [15].…”