The Qualities of a good rural hospital. A NZ 2017 perspective.
“A rural hospital can be compared to a ketei – whereby like the flax strands, culture, ideology and values are interwoven with systems, workforce, facilities, social and geographical context to become a purposeful provider of rural health care.”
The rural hospital kete: Ruth Upsdell 2017
In 2002 students and faculty of Otago University’s postgraduate rural programme, (then in the Department of General Practice and Rural Health, Dunedin School of Medicine), wrote a document titled ‘The Good Rural Hospital’ which has since been core reading for the paper GENA724: ‘The Context of Rural Hospital Medicine’. The intent in writing this 2017 document was to update the original document given the intervening period of 15 years.
This document was written by the 2017 students and faculty of GENA724 ‘The Context of Rural Hospital Medicine’ paper (now part of the post-graduate rural programme, Department of the Dean, Dunedin School of Medicine) with input from the wider post graduate rural programme faculty.
This is an aspirational document describing the specific role of the hospital as one part of wider rural health services. While recognising that there is and needs to be a wide variation of rural hospitals in New Zealand the document’s focus is on commonalities that define rural hospital practice.
The document (like the 2002 version) is written by doctors and as such represents a significant bias towards the views of the medical team. We acknowledge that other members of the rural hospital team and the community may have a significantly different, but equally important, view of the place of the rural hospital.
Students and faculty of Rural Postgraduate Programme, University of Otago. The Good Rural Hospital: New Zealand 2017 Edition 1. 2017 accessed from: https://blogs.otago.ac.nz/rural/2019/06/13/good-rural-hospital-2017/
Link to The Good Rural Hospital 2017 e1 full text document
Amanda van Zyl
On a pleasant autumn evening on the first of May (May Day) fifty five members of the Matagouri Club motored their way to Balclutha to visit Clutha Health First, have an evening meal and view the Mobile Surgical Services bus. Amongst the fifty five were forty medical and fifteen dental students. This is an annual event sponsored by RMIP. Matagouri Club is the rural undergraduate club of the Health Sciences students of University of Otago. They were presented with the Clutha Health First story by Branko Sijnja who described the community’s efforts to firstly try to save their 120 bed rural hospital and when that proved unsuccessful design a new sustainable community owned model that is now the successful facility occupied by general practices, an inpatient ward, diagnostic services and community services for the people of the Clutha District.
They enjoyed fifty five take away meals lovingly prepared by the Raj Indian Restaurant of Balclutha (no doubt the best Indian Restaurant in New Zealand). Great food, great taste, great portions and great variety.
The RMIP students based in Balclutha escorted the students around the facility and then they visited the Mobile Surgical Services bus which was preparing for an operating list the next day. A very successful day.
Dr Branko Sijnja | MBChB, FRNZCGP, FNZMA, PGDipObst, PGDipRPHP, PGDipGP | Director Rural Medical Immersion Programme
Blattner K, Beazley CJ, Nixon G, Herd G, Wigglesworth J, Rogers-Koroheke MG. The impact of the introduction of a point-of-care haematology analyser in a New Zealand rural hospital with no onsite laboratory. Rural and Remote Health 2019; 19: 4934. https://doi.org/10.22605/RRH4934 Open Access link
Mixed methods study from the team at Rawene in the Far North showing the, sometimes significant, impact of having a point-of-care FBC analyser in their small rural hospital. Knowledge is power and cost saving… Interesting that the largest cost saving is for the base hospital – something that seems like is missed in funding discussions.
Kati is a senior member of the rural section and convenes GENA 724 – The context of rural hospital medicine.
Hokianga Hospital is a small rural hospital in the far north of New Zealand serving a predominantly Maori population of 6500. The hospital, an integral part of a comprehensive primary healthcare service, provides continuous acute in-hospital and emergency care. Point-of-care (POC) biochemistry has been available at the hospital since 2010 but there is no onsite laboratory. This study looked at the impact of introducing a POC haematology benchtop analyser at Hokianga Hospital.
This was a mixed methods study conducted at Hokianga Hospital over 4 months in 2016. Quantitative and qualitative components and a cost–benefit analysis were combined using an integrative process. Part I: Doctors working at Hokianga Hospital completed a form before and after POC haematology testing, recording test indication, differential diagnosis, planned patient disposition and impact on patient treatment. Part II: Focus group interviews were conducted with Hokianga Hospital doctors, nurses and a cultural advisor. Part III: An analysis of cost versus tangible benefits was conducted.
Part I: A total of 97 POC haematology tests were included in the study. Of these, 97% were undertaken in the setting of the acute clinical presentation and 72% were performed out of hours. The average number of differential diagnoses reduced from 2.43 pre-test to 1.7 post-test, (χ2 tests p<0.05). There was a significant reduction in the number of patients transferred and an increase in the number of patients discharged home (χ2 tests p<0.05). Part II: Three main themes were identified: impact on patient management, challenges and the commitment to ‘make it work’. POC haematology had a positive impact on patient management and clinician confidence mainly by increasing diagnostic certainty. The main challenges related to the hidden costs of implementing the analyser and its associated quality assurance program in a remote-from-laboratory setting. Part III: Tangible cost–benefit analysis showed a clear cost saving to the health system as a whole.
This is the first published study evaluating the impact of haematology POC testing on acute clinical care in a rural hospital with no onsite laboratory. Timely access to a full blood count POC improves clinical care and addresses inequity. There was an overall reduction in healthcare costs. The study highlighted the hidden costs of implementing POC systems and their associated quality assurance programs in a remote-from-laboratory context.
Otago demonstrates its commitment to rural health with new ‘virtual campus’
Tuesday, 7 August 2018
The University of Otago has reiterated its commitment to training and education in rural health with the establishment of a new Section of Rural Health, believed to be the first dedicated rural health unit currently operating within a New Zealand tertiary. Continue reading