Abstract
OBJECTIVE: The 2004 earthquake/tsunami devastated Southeast Asia. We studied point-of-care testing (POCT) and O2 saturation monitoring in Phang Nga, hardest hit southern coastal province, to develop preparedness strategies for low-resource small-world networks (SWNs). DESIGN, SETTING, AND PARTICIPANTS: Early 2005, we surveyed 4 provinces then, in 2007-2011, focused on Phang Nga with new field/phone/mail/e-mail/fax surveys of 7 primary care units, all 7 community hospitals, and both regional hospitals. We used short-and long-form Thai surveys, photodocumented instruments, and assessed resources. Chiang Rai, unaffected by the tsunami in the north, served as control for pulse oximeter utilization. RESULTS: Community hospital laboratories installed electrolyte analyzers. Pulse oximeters increased in Phang Nga, but fell short of the number used in the control province (P < 0.05). Nurses reported uncertainty with calibration. Glucose meters remained common. Community hospital microbiology was deficient. Dengue hemorrhagic fever outbreaks required hourly bedside spun hematocrits for transfusion decisions. Prolonged SWN travel times and ambulance shortages still render transport vulnerable. Helicopters are unavailable. CONCLUSIONS: Overall, preparedness for medical testing improved significantly. Pulse oximeters to monitor oxygenation status during ambulance transfer, emergency department evaluation, and ventilation became available more widely and, in the future, should be matched by adequate blood gas analyzers for timely O2 saturation validations, plus critical arterial PO 2, PCO2, and pH measurements. Quality control education in POCT must parallel increasing use. Continuous noninvasive hemoglobin monitoring of dengue patients could save time when transfusing blood frequently. Value proposition strategies built on post-tsunami advances enhance SWN POCT preparedness, as well as daily emergency care.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 9-22 |
| Number of pages | 14 |
| Journal | Point of Care |
| Volume | 12 |
| Issue number | 1 |
| DOIs | |
| State | Published - Mar 2013 |
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Keywords
- and telemedicine
- cardiac troponin (cTn)
- community hospital
- continuous hemoglobin monitoring
- low-resource setting
- primary care unit (PCU)
- pulse oximeter
- strategic tactics
ASJC Scopus subject areas
- Nursing(all)
Cite this
Point-of-care testing value proposition for disaster preparedness in small-world networks : Post-tsunami phang nga province, Coastal Thailand. / Kost, Gerald J; Katip, Pratheep; Kulrattanamaneeporn, Shayanisawa; Gentile, Nicole.
In: Point of Care, Vol. 12, No. 1, 03.2013, p. 9-22.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Point-of-care testing value proposition for disaster preparedness in small-world networks
T2 - Post-tsunami phang nga province, Coastal Thailand
AU - Kost, Gerald J
AU - Katip, Pratheep
AU - Kulrattanamaneeporn, Shayanisawa
AU - Gentile, Nicole
PY - 2013/3
Y1 - 2013/3
N2 - OBJECTIVE: The 2004 earthquake/tsunami devastated Southeast Asia. We studied point-of-care testing (POCT) and O2 saturation monitoring in Phang Nga, hardest hit southern coastal province, to develop preparedness strategies for low-resource small-world networks (SWNs). DESIGN, SETTING, AND PARTICIPANTS: Early 2005, we surveyed 4 provinces then, in 2007-2011, focused on Phang Nga with new field/phone/mail/e-mail/fax surveys of 7 primary care units, all 7 community hospitals, and both regional hospitals. We used short-and long-form Thai surveys, photodocumented instruments, and assessed resources. Chiang Rai, unaffected by the tsunami in the north, served as control for pulse oximeter utilization. RESULTS: Community hospital laboratories installed electrolyte analyzers. Pulse oximeters increased in Phang Nga, but fell short of the number used in the control province (P < 0.05). Nurses reported uncertainty with calibration. Glucose meters remained common. Community hospital microbiology was deficient. Dengue hemorrhagic fever outbreaks required hourly bedside spun hematocrits for transfusion decisions. Prolonged SWN travel times and ambulance shortages still render transport vulnerable. Helicopters are unavailable. CONCLUSIONS: Overall, preparedness for medical testing improved significantly. Pulse oximeters to monitor oxygenation status during ambulance transfer, emergency department evaluation, and ventilation became available more widely and, in the future, should be matched by adequate blood gas analyzers for timely O2 saturation validations, plus critical arterial PO 2, PCO2, and pH measurements. Quality control education in POCT must parallel increasing use. Continuous noninvasive hemoglobin monitoring of dengue patients could save time when transfusing blood frequently. Value proposition strategies built on post-tsunami advances enhance SWN POCT preparedness, as well as daily emergency care.
AB - OBJECTIVE: The 2004 earthquake/tsunami devastated Southeast Asia. We studied point-of-care testing (POCT) and O2 saturation monitoring in Phang Nga, hardest hit southern coastal province, to develop preparedness strategies for low-resource small-world networks (SWNs). DESIGN, SETTING, AND PARTICIPANTS: Early 2005, we surveyed 4 provinces then, in 2007-2011, focused on Phang Nga with new field/phone/mail/e-mail/fax surveys of 7 primary care units, all 7 community hospitals, and both regional hospitals. We used short-and long-form Thai surveys, photodocumented instruments, and assessed resources. Chiang Rai, unaffected by the tsunami in the north, served as control for pulse oximeter utilization. RESULTS: Community hospital laboratories installed electrolyte analyzers. Pulse oximeters increased in Phang Nga, but fell short of the number used in the control province (P < 0.05). Nurses reported uncertainty with calibration. Glucose meters remained common. Community hospital microbiology was deficient. Dengue hemorrhagic fever outbreaks required hourly bedside spun hematocrits for transfusion decisions. Prolonged SWN travel times and ambulance shortages still render transport vulnerable. Helicopters are unavailable. CONCLUSIONS: Overall, preparedness for medical testing improved significantly. Pulse oximeters to monitor oxygenation status during ambulance transfer, emergency department evaluation, and ventilation became available more widely and, in the future, should be matched by adequate blood gas analyzers for timely O2 saturation validations, plus critical arterial PO 2, PCO2, and pH measurements. Quality control education in POCT must parallel increasing use. Continuous noninvasive hemoglobin monitoring of dengue patients could save time when transfusing blood frequently. Value proposition strategies built on post-tsunami advances enhance SWN POCT preparedness, as well as daily emergency care.
KW - and telemedicine
KW - cardiac troponin (cTn)
KW - community hospital
KW - continuous hemoglobin monitoring
KW - low-resource setting
KW - primary care unit (PCU)
KW - pulse oximeter
KW - strategic tactics
UR - http://www.scopus.com/inward/record.url?scp=84874946090&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874946090&partnerID=8YFLogxK
U2 - 10.1097/POC.0b013e318265f3d4
DO - 10.1097/POC.0b013e318265f3d4
M3 - Article
AN - SCOPUS:84874946090
VL - 12
SP - 9
EP - 22
JO - Point of Care
JF - Point of Care
SN - 1533-029X
IS - 1
ER -