The Northern Territory Point-of-Care Testing Program (NT POCT Program) is a well-established field program that supports quality-assured point-of-care testing on the Abbott i-STAT and HemoCue® WBC DIFF devices for the care of patients with acute and chronic health conditions.
The i-STAT measures multiple pathology test profiles including blood electrolytes, urea, creatinine, glucose, blood gases and lactate, cardiac troponin I and INR. We support i-STAT devices in approximately 80 remote health centres across the Northern Territory & the Ngaanyatjarra Lands.
The WBC DIFF network operates in 20 sites in the NT's Top End and delivers a total white blood cell count, plus a 5-part differential white blood cell count.
Since it began in 2008, this program has proven to be operationally effective. The number of patient tests conducted annually has increased ten-fold and qualitative research has demonstrated a high level of satisfaction with the program among a range of stakeholders including doctors, remote area nurses and Aboriginal Health Practitioners.
The i-STAT POCT program is also clinically effective, with particular impact on improving clinical outcomes for cardiac and acutely ill patients. Many remote health staff have commented that the use of the i-STAT has enabled patients to be safely monitored and stabilised on-site and led to improved patient safety in remote communities.
There have been multiple instances of saved medical evacuations due to the ability to conduct on-site POC testing to evaluate the immediate clinical status of patients (with resultant cost savings of approximately $21 million per annum for the Northern Territory Government).
White cell counts are an important diagnostic tool for detecting acute and general infections, but obtaining reliable test results in a timely manner from pathology laboratories presents significant challenges for remote communities. These challenges include long specimen transport times and issues related to specimen integrity during transport. Our 2017 study found that more than 25% of tests ordered by remote communities were reported by their nearest laboratory as 'unreliable', 'unsuitable' and 'not reported' due to these issues.
In response to this, NT Health and the Flinders University International Centre for Point-of-Care Testing examined the analytical, clinical and cost effectiveness of a point-of-care testing device for total white cell counts and their subtypes. In 2020, this study led to the introduction of HemoCue(R) WBC DIFF devices to 20 remote clinics in the Northern Territory's Top End region. The WBC DIFF device generates a total white cell count and a 5-part differential white blood cell count in under 5 minutes.
Based on our research the WBC DIFF POCT program is expected to have significant benefits for Top End communities, including rapid identification and timely treatment of patients with infection/sepsis, more effective triage of patients who require evacuation (by making informed clinical decisions on-site as a result of access to POC testing), and cost savings due to prevented medical evacuations.
The NT POCT Program is governed by the NT POCT Management Committee, a collaborative partnership between the Flinders University International Centre for Point-of-Care Testing (ICPOCT), Northern Territory Government - NT Health and Aboriginal Medical Services Alliance Northern Territory (AMSANT).
The primary role of the Management Committee is to ensure accountability for decision making and the efficient delivery of the NT POCT Program. Members of the committee facilitate communication to all relevant stakeholders involved with point-of-care testing in the NT.
The Management Committee is comprised of the following members:
International Centre for Point-of-Care Testing
Chair and Program Manager
NT POCT Program Coordinators (WBC DIFF and i-STAT)
Regional POCT Supervisor Central Australia region
Regional POCT Supervisor Top End region
Representative for Aboriginal Community Controlled Health Services
We are funded by the Northern Territory Government - NT Health.
We have published quite a few papers about our work in the NT POCT Program. Check them out below.
Matthews, SJ, Spaeth, B, Duckworth, L, Richards, JN, Prisk, E, Auld, M, Quirk, T, Omond, R & Shephard, MDS 2020, 'Sustained quality and service delivery in an expanding point-of-testing network in remote Australian Primary Health Care', Archives of Pathology and Laboratory Medicine, vol. 144, no. 11, 2020-0107-OA, pp. 1381-1391. https://doi.org/10.5858/arpa.2020-0107-OA
Shephard, M, Motta, L, Spaeth, B, Halls, H & Duckworth, L 2019, Point-of-care testing for blood counts, HbA1c, renal function, electrolytes, acid-base balance and hepatitis. in K Atkinson & D Mabey (eds), Revolutionizing Tropical Medicine: Point-of-Care Tests, New Imaging Technologies and Digital Health. John Wiley & Sons, pp. 247-269. https://doi.org/10.1002/9781119282686.ch16
Spaeth, B, Shephard, M, Kockcinar, R, Duckworth, L & Omond, R 2019, 'Impact of point-of-care testing for white blood cell count on triage of patients with infection in the remote Northern Territory of Australia', Pathology, vol. 51, no. 5, pp. 512-517. https://doi.org/10.1016/j.pathol.2019.04.003
Spaeth, BA, Kaambwa, BC, Shephard, MDS & Omond, R 2018, 'Economic evaluation of point-of-care testing in the remote primary health care setting of Australia's Northern Territory', ClinicoEconomic and Outcomes Research, vol. 10, pp. 269-277. https://doi.org/10.2147/CEOR.S160291
Spaeth, BA, Shephard, MDS & Omond, R 2017, 'Clinical application of point-of-care testing in the remote primary health care setting', Quality in Primary Care, vol. 25, 19705, pp. 164-175. http://primarycare.imedpub.com/clinical-application-of-pointofcare-testing-in-theremote-primary-health-care-setting.php?aid=19705
Spaeth, BA & Shephard, MDS 2016, 'Clinical and operational benefits of international normalized ratio point-of-care testing in remote indigenous communities in Australia's Northern Territory', Point of Care, vol. 15, no. 1, pp. 30-34. https://doi.org/10.1097/POC.0000000000000082
Spaeth, BA, Shephard, MD, McCormack, B & Sinclair, G 2015, 'Evaluation of HemoCue White Blood Cell Differential Counter at a Remote Health Centre in Australia's Northern Territory.', Pathology, vol. 47, no. 1, pp. 91-95. https://doi.org/10.1097/PAT.0000000000000202
Shephard, MDS, Spaeth, BA, Mazzachi, BC, Auld, M, Schatz, S, Lingwood, A, Loudon, J, Rigby, J & Daniel, V 2014, 'Toward Sustainable Point-of-Care Testing in Remote Australia: the Northern Territory i-STAT Point-of-Care Testing Program ', Point of Care: The Journal of Near-Patient Testing and Technology, vol. 13, no. 1, pp. 6-11. https://doi.org/10.1097/POC.0000000000000009
Shephard, M, Spaeth, B, Mazzachi, B, Auld, M, Schatz, S, Loudon, J, Rigby, J & Daniel, V 2012, 'Design, implementation and initial assessment of the Northern Territory Point-of-Care Testing Program', Australian Journal of Rural Health, vol. 20, no. 1, pp. 16-21. https://doi.org/10.1111/j.1440-1584.2011.01243.x
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