This evaluation assessed the impact of introducing point-ofcare (POC) haematology testing in Hokianga Hospital, a small rural hospital in the far north of New Zealand serving a predominantly Māori population of 6,500 people. POC biochemistry has been available at the hospital since 2010, but it lacks an onsite laboratory. This 3-part investigation was conducted at Hokianga Hospital over 4 months in 2016. In Part 1, hospital doctors completed a form before and after POC haematology testing, recording test indication, differential diagnosis, planned patient disposition and impact on patient treatment. In Part 2, focus group interviews were conducted with hospital doctors, nurses and a cultural advisor. Part 3 of the study involved an analysis of cost versus tangible benefits. Analysis of the 97 POC haematology tests (97% were performed during the acute clinical presentation; 72% were performed out of hours) revealed a significant reduction in the average number of differential diagnoses, from 2.43 pre-testing to 1.7 post-testing (p<0.05). Haematology POC testing was also associated with significant reductions in the number of patients transferred and significantly increased the number of patients discharged home (both p<0.05). Analyses of the interview transcripts revealed 3 key themes: impact on patient management, challenges, and the commitment to ‘make it work’. POC haematology positively impacted patient management and clinician confidence, mainly by increasing diagnostic certainty. Respondents cited challenges surrounding the testing as issues relating to the hidden costs of implementing the analyser and its associated quality assurance programme in a remote-from-laboratory setting. A cost– benefit analysis demonstrated savings in healthcare costs.
