Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study

Abstract

Introduction: This study was chosen due to long waiting time at various stages before doctors/ pharmacists saw patients at warfarin clinic. Objectives: The objectives are to identify stages contributing to waiting time and to assess efficacy of point-of-care testing (POCT) in reducing waiting time at warfarin clinic. Methodology: This study was conducted in two phases. Phase 1 (pre intervention) consisted of 171 patients attending warfarin clinic over three weeks (06/04/2015-27/ 04/2015). Phase 2 (post intervention) consisted of 148 patients (26/10/2014-09/11/2015). Patients with rejected INR samples and multiple clinics on the same day were excluded. Data were analysed using SPSS 17. Results/Discussion: 171 patients were recruited in phase 1. 67.3% (115) Malays, 22.8% (39) Chinese, 9.4% (16) Indians and 0.6% (1) others. The mean age was 62.8 years. 54.4% (93) were males compared to 45.6% (78) females. Significant waiting time was from arrival of patient at venepuncture to blood taking which was 38.3 minutes ± 19.3, p < 0.001. Blood taken at venepuncture to sample arrive at laboratory was 29.1 minutes ± 13.9, p < 0.001. The mean time to see pharmacist was 44.2 minutes ± 24.5. The mean time to see doctor for both stable/deranged INR was 58.7 ± 27.1, p < 0.001. Average 36.7 minutes ± 23.8 was spent at doctor’s room, p < 0.001. Time spent from pharmacist receiving prescription to warfarin dispensed was 16.3 ± 7.2, p < 0.001. Percentage of patients with total waiting time in the post intervention study (arrival at venepuncture to dispensing of warfarin) less than 180 minutes is 96.7% (compared to 21.6% in the pre intervention group). The set standard is 80%. Causes contributing towards excessive waiting time were delay in transporting samples to laboratory, delay in blood taking at venepuncture, delay in sending results to warfarin clinic and poor delegation of task between doctors/pharmacists. The signifycant improvement in waiting time was attributed to the point-of