529 / Point of Care Testing to avoid unnecessary hospital transfers in rural areas

the PSP
Type of Patient Safety Practice Safe
Clinical Practice (CP)
Related practices from PaSQ database
“Best fit” category of the reported practice


Handover situations / Transfer of patients
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
One of the basic objectives of our health system for the continuous improvement of healthcare quality and encouraging clinical excellence is the patient’s safety. Therefore, quality and safety go hand in hand. For this reason, many international organisations including, the World Health Organisation (WHO), the Organisations for Patient Safety (OPS), the European Health Committee of the European Council and the Joint Commission, and national ones such as the Ministry of Health, Social Services and Equality, have included this topic in their list of priorities. By analysing the risks in health care, it has been shown that they are due to diverse and heterogeneous causes and they can be linked either to the procedure or type of work, the technology or associated with the people who carry out this work or who take part in it in some way. Therefore, we decided to analyse the weak points regarding access to the laboratories by centres and other possible areas of improvement in the health context where we carry out our activity, in order to establish strategies and make decisions to improve Patient Safety. The intake area of Ronda Hospital covers a population of more 120,000 inhabitants in two different provinces, structured into six Basic Health Areas with their corresponding primary healthcare centres plus three associated Specialized Medical Centres, making a total of thirty different points of medical care. The “Serranía de Ronda” Rural Area has some complicated geographical characteristics due to its being a mountainous area. It is geographically dispersed and of difficult communication due to the secondary roads which are even worse in winter. The mean transfer times to Ronda Hospital, which is the only hospital in the Region, are approximately 60 minutes. With the exception of obstetric problems, the most frequent causes of hospital admission are chronic respiratory diseases and their complications and congestive cardiac and coronary diseases. The population profile of the Rural Area is characteristic of an ageing population. The population pyramid shows that more than 18% of the population is over 65 years and the trend is towards an increase in the next few years. Therefore, it is mainly a very vulnerable population. By using nominal groups quantitative methods performed in all the Primary Health Care Centres in our reference area in which different categories of staff involved took part, a situation analysis was performed on Patient Safety in the Health Area. The geographic dispersion and difficulty in reaching the hospital were detected as priority problems and as those aspects that would have most influence on patient safety, particularly in emerging situations. The use of point of care testing can reduce the lapse of assistance and avoid unnecessary transfers.
Description of the Patient Safety Practice
Once this problem was identified and given the complexity of finding a solution, the possibility of providing the health centres with greater freedom in laboratory diagnostic tests was studied by an expert group. Nowadays, more than 85% of patients on oral anticoagulants are monitored in the primary healthcare centre, more than 6000 diabetic patients are seen in the diabetic clinics in those centres and in order to assist more than 5500 home emergencies, the ambulances have portable dry chemistry multi-parameter analytical instruments. To serve the whole of this population, until now, there are 550 glucometers, 45 coagulometers and 11 portable dry chemistry analysers in the ambulances. The tests available in the ambulances are: glucose, creatinine, ions, gasometry arterial and venous, ionic calcium, troponine, hemograme and hematocrit. The results are available in 120 seconds. However and in order to ensure quality control of all the devices, it was decided that all the analysers and all the users would have to be registered in a computer database. Therefore a computer platform (web page) has been designed (and developed) for this control and maintenance of all the equipment. This platform has been set up with the following characteristics: accessible (from any work site), secure (with different access profiles), flexible (modifiable according to needs and what is going to be generated), centralised (it is a single database) and as a document manager (access to reports). This system records the quality controls, reference numbers, reagent lots and the controls of each instrument, as well as the values achieved in the control and calibration program. It can calculate Levy-Jennings and Youden curves. There is an e-mail link with the user responsible for the analyser to notify any incident or non-compliance with the quality control program. The information is provided by the user him/herself via the web or by voice portal in difficult to cover areas and received in the Hospital Laboratory. To be correctly implemented, training courses have been given to the managers of the Basic Health Areas as well as doctors and nurses, which were very well received. The staff positively valued the availability of these diagnostic tools with the certainty of obtaining high quality results, as well as having been given a response to their demands regarding patient safety. The results in those years have shown that the patient transfer to the hospital has decreased in a 20%. The ambulances and their staff have increased their capacity of resolution avoiding unnecessary transfer. This practice is focused specially in the professionals who work in widely dispersed areas or in emergencies. The military support is available to access to remote areas.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
Effectiveness of the Patient Safety Practice
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
A baseline measurement before implementation of the reported practice was obtained
A measurement after full implementation of the reported practice was obtained
Evaluation of a “positive” effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Enclosure of a reference or attachment in case of published evaluation’s results
Mérida FJ, Moreno EE. Development and implementation of a computer platform for the quality control of poct analysers as a strategy to improve patient safety in a rural area. XX International Congress of Clinical Chemistry and Laboratory Medicine. Fortaleza, Brasil. 27 sept-2 oct de 2008. [Clin Chem Lab Med 2008;46 Special Suppl, pp S1-S859].

Mérida De la Torre F.J., Moreno Campoy E.E. Development and implementation of POCT in mobile critical care units for improved patient safety in rural areas. AACC POCT. International Symposium. [Point of care. 2008. Vol. 7 (3) 153-54].

Mérida De La Torre FJ, Moreno Campoy EE. Utilidad de los sistemas analíticos a la cabecera del enfermo en condiciones emergentes y con accesibilidad limitada. Revista Sanidad Militar. 2010;66 (4):223-227.

Health care context where the Patient Safety Practices was implemented
Primary care
Nursing facility
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Specification of implementation in another health care setting(s)
Successful implementation’s level  of this Patient Safety Practice across settings
Yes, across multiple specialities within the same setting
Involved health care staff
Clinical manager
Patient Involvement
Direct service user’s involvement as integral part of this Patient Safety Practice
Specification of the service users or their representatives’ involvement in the implementation of this Patient Safety Practice
Point of time in which service user or their reprasentatives’ involvement takes place
During the development of the Patient Safety Practices
Active seeking of service users’ opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Short description of the service users’ level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
No motivation among staff
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Costs of the Patient Safety Practices
Completion of cost calculation related to this Patient Safety Practice
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 15
External consultants: 2
Support staff: 2
Managerial staff: 1
Others: 0
Not relevant: 0
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: 4
External consultants: 2
Support staff: 0
Managerial staff: 0
Others: 0
Not relevant: 0
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice