12. Rural Health – Tests Available Locally

The availability of diagnostic services like blood tests, X-rays, ultrasounds, and CT scans in rural hospitals in Australia varies significantly based on the location, hospital size, and funding. Here is an overview of each type of diagnostic service in the context of rural healthcare:

  1. Blood Tests:
    • Blood tests are among the most basic diagnostic tools and are generally available in most rural hospitals in one form or another.
    • The most basic of these are strip-based glucose, ketone and INR machines of the type found in many general practices.
    • Most rural hospitals will have an iSTAT machine, a self-contained cartridge-based blood testing machine that produces results in 5-10 minutes. Commonly available cartridges include:
      • CG4+ Cartridge:
        • Measures pH, PCO2, PO2, and lactate. Used primarily for assessing respiratory and metabolic functions.
      • CG8+ Cartridge:
        • Measures pH, PCO2, PO2, Na+, K+, iCa++, Cl-, and glucose. Useful for comprehensive metabolic evaluations.
      • CHEM8+ Cartridge:
        • Measures Na+, K+, Cl-, iCa++, glucose, urea (BUN), creatinine, and Hct.
      • TROP I Cartridge:
        • Measures cardiac troponin I.
    • Larger rural hospitals have on-site pathology services for routine tests such as complete blood counts (CBC), blood sugar levels, and lipid profiles.
    • For more specialized tests, samples may need to be sent to larger laboratories in urban centers, which can delay results by days
  2. X-ray:
    • X-ray services are typically available in rural hospitals with an on-call radiographer +/- remote operator licence for the local GP
    • The technology required for X-ray imaging is relatively basic compared to other imaging techniques, which makes it easier to maintain in smaller and more remote hospitals.
  3. Ultrasound:
    • Ultrasound machines are also commonly found in rural hospitals but might not be available in the smallest or most remote facilities.
    • The availability of trained sonographers can be a limiting factor.
    • In some cases, visiting specialists from urban centres provide periodic ultrasound services.
  4. CT Scans:
    • CT scanners are much less common in rural hospitals compared to X-ray and ultrasound equipment.
    • CT scanners are expensive to purchase and maintain, and they require specially trained technicians to operate.
    • Rural hospitals may only have CT scanning capabilities if they are larger regional centres.
    • Typically, patients requiring a CT scan are transferred to larger hospitals.

Challenges and Solutions

  • Staffing and Training:
    • Rural hospitals often struggle with staffing.
    • It’s not only a matter of having the right equipment but also having trained professionals to operate them.
    • Ongoing training and support for rural health professionals are crucial.
  • Funding and Resources:
    • Diagnostic services are expensive to set up and maintain.
    • Rural hospitals often operate with limited budgets, making it difficult to procure and maintain advanced diagnostic technology like CT scanners.
  • Access and Distance:
    • For services not available locally, patients must travel long distances to access necessary diagnostics, adding time and expense.
    • This can be particularly challenging for urgent cases.
  • Telehealth and Mobile Services:
    • To mitigate these challenges, telehealth services have been expanded, allowing for remote consultations and some level of diagnostic oversight.
    • Additionally, mobile diagnostic services, such as mobile CT units, occasionally visit remote areas to provide access to advanced imaging.

Overall, while basic diagnostic services like blood tests and X-rays are typically available in rural hospitals in Australia, more sophisticated imaging services such as ultrasounds and particularly CT scans might only be available in larger regional centers. The Australian government and various health organizations continue to work on improving access to these essential services in rural and remote areas.

i-STAT


In rural and remote healthcare settings in Australia, where access to comprehensive laboratory facilities can be limited, point-of-care testing (POCT) devices like the i-STAT system play a crucial role in improving the scope and speed of diagnostics. These devices enable critical tests to be conducted at the bedside, facilitating immediate clinical decisions.

  1. i-STAT System:
    • The i-STAT is a portable clinical analyzer that is used widely in various settings, including rural and remote healthcare facilities.
    • It can perform a range of tests on a single platform using only a few drops of blood.
    • The results are available within minutes, which is invaluable in emergency situations or when rapid decision-making is required.
    • It comes with a small printer so the results can be added (using sticky tape) to the hospital notes.
  2. Cartridges:
    • A number of different cartridges are available. The ones that are typically on hand are:
    • i-STAT CG4+: This cartridge is used for blood gas analysis, which includes measurements such as pH, carbon dioxide, oxygen, and lactate levels. These parameters are critical for assessing respiratory function and managing conditions such as respiratory distress, metabolic imbalances, and shock.
    • i-STAT CG8+: This cartridge provides a broader panel of tests, including blood gases plus electrolytes and metabolites Na+, K+, Cl-, iCa++, glucose. This comprehensive testing is crucial for managing a wide range of acute medical conditions and for monitoring ongoing treatment.
    • i-STAT CHEM8+: This cartridge measures Na+, K+, Cl-, iCa++, glucose, urea (BUN), creatinine, and Hct.
    • i-STAT cTnI: This test allows for the rapid measurement of troponin levels, facilitating early diagnosis and management of cardiac events.

Impact and Challenges in Rural Settings:

  • Immediate Clinical Action:
    • The ability to obtain critical diagnostic results quickly with devices like the i-STAT allows healthcare providers in rural areas to make informed decisions promptly.
    • This is especially important in acute cases where every minute counts.
    • The availability of a POCT device like the i-STAT for troponin testing is particularly beneficial in rural hospitals where the nearest cardiology centre might be hours away.
    • Early diagnosis can lead to quicker initiation of appropriate therapies, potentially improving outcomes.
  • Reduced Need for Transfers:
    • By providing on-the-spot testing, devices such as the i-STAT can reduce the need for patients to be transferred to larger hospitals for diagnostic evaluation.
    • This not only saves critical time and resources but also alleviates the patient’s burden of traveling to distant healthcare facilities.
  • Training and Maintenance:
    • While the i-STAT and similar devices are designed for ease of use, ongoing training for medical staff is essential to ensure accurate operation and interpretation of results.
    • The cartridges are sensitive to overfill and underfill errors, which can be fixed by purchasing a lab-grade pipette rather than trying to apply the correct volume of blood with a syringe.
    • Regular maintenance and calibration of the equipment are also necessary to avoid errors, which can be challenging in remote locations.
  • Cost and Resource Allocation:
    • Although POCT devices are cost-effective in terms of clinical benefits, the initial outlay and the cost of consumables (like cartridges) can be significant.
    • Budget constraints in rural health facilities may limit the availability of these advanced testing options.
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