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Point-of-care solutions for quick detection of influenza

Winter flu outbreaks inevitably see patient numbers increasing in hospital emergency departments every year, leaving many trusts searching for efficient solutions to quickly and accurately diagnose and direct patients with influenza-like symptoms. 

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Winter flu outbreaks inevitably see patient numbers increasing in hospital emergency departments every year, leaving many trusts searching for efficient solutions to quickly and accurately diagnose and direct patients with influenza-like symptoms. Several hospitals, including Addenbrooke’s in Cambridge, have embraced new point-of-care tests to help control the spread of influenza, and to assist patient flow and bed management. Michelle Lineham, Point-of-care Testing (POCT) Team Lead and Biomedical Scientist at Addenbrooke’s, discusses the positive impact that the implementation of a new diagnostic strategy using POCT has had on patient management and its associated costs.

Addenbrooke’s Hospital forms part of the Cambridge University Hospitals (CUH) NHS Foundation Trust – one of the largest trusts in England – and offers general, specialist, women’s and maternity care. This busy hospital has a uniquely large standalone POCT team, with 27 staff in various roles, that helps to oversee POCT within the trust and provides patient testing facilities in the emergency and oncology departments. This helps to improve the patient experience by providing rapid turnaround of specimens as an alternative to the central laboratory and, at the same time, allow the central laboratory to stay focussed on more specialist testing. The team also contributes to a winter steering group – comprised of healthcare professionals from various disciplines – that is responsible for making strategic decisions on how to manage the impact of respiratory viruses on the organisation at this busy time of year.

After a particularly bad winter in 2016, the POCT team was asked to introduce a new test as a matter of urgency to tackle the large volume of patients with suspected flu. Many patients arrive at the emergency department (ED) suffering from a medical problem, but also displaying flu-like symptoms; a point-ofcare test can aid decision-making on administering antivirals, and whether the patient needs to be admitted or can be discharged. A rapid antigen detection test was implemented as a short-term measure in an attempt to help the ED with its decision-making protocols. Unfortunately, many cases of flu were missed due to a combination of sensitivity issues and variable user techniques. As a result, the ED continued to rely on batch testing twice a day in the central laboratory, which was more accurate, but increased the time taken to generate results by over 24 hours.

A need for change There was a clear need to implement an alternative point-of-care solution to assist the ED in diagnosing and directing patients with flu and RSV. To address this, the point-of-care team evaluated the efficiency of Cepheid’s GeneXpert® System and Xpert® Xpress Flu/RSV test cartridge (an in vitro medical diagnostic) in the winter of 2017. The GeneXpert System was chosen because of its fast turnaround times and ease of use – which are ideal for a busy ED – as well as for its four self-contained modules that work independently of each other and enable a flexible, high throughput. The small footprint of the system also overcomes space restrictions within the ED’s POCT facility and, as the cassettes can be stored at room temperature, this saves precious fridge space. This new method was easily ADVERTISEMENT FEATURE Cepheid Point-of-care solutions for quick detection of influenza Winter flu outbreaks inevitably see patient numbers increasing in hospital emergency departments every year, leaving many trusts searching for efficient solutions to quickly and accurately diagnose and direct patients with influenza-like symptoms. Several hospitals, including Addenbrooke’s in Cambridge, have embraced new point-of-care tests to help control the spread of influenza, and to assist patient flow and bed management. Michelle Lineham, Point-of-care Testing (POCT) Team Lead and Biomedical Scientist at Addenbrooke’s, discusses the positive impact that the implementation of a new diagnostic strategy using POCT has had on patient management and its associated costs. incorporated into the existing ED protocol, enabling flu results to be generated within 30 minutes.

Reducing costs and saving time
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After a successful evaluation during 2017, the GeneXpert System was officially rolled out for the winter of 2018-19. The rapid molecular testing it provides has vastly improved the consistency of flu detection at the hospital for patients coming in via the ED. Even allowing for variations in flu numbers year on year, figures show significant improvements, with a greater proportion of patients with flu not admitted during the winter of 2018-19 compared to the previous years (see figure 1).

The rapid turnaround the GeneXpert System offers has allowed clinicians to make a variety of decisions about patient care while they are still in the ED; the average time from swabbing, to result, to a doctor assessing the patient, has reduced to 50 minutes with the point-ofcare test, compared to 28 hours for standard batch testing. This has had several knock-on effects, including better treatment guidance and effective isolation. Antivirals can now be administered to patients sooner and more appropriately because there is less uncertainty as to whether they actually have flu or not. The number of oseltamivir courses started for patients who were subsequently found not to have influenza decreased from 1,527 in 2017-18 to 473 in 2018-19, significantly reducing the number of unnecessary prescriptions, saving the trust money and improving patient care. In contrast, when point-of-care flu testing was not performed, only 42 per cent of patients started antiviral treatment promptly, whereas this figure rose to 86 per cent once POCT was established. Cases of hospital-acquired influenza (HAI) also decreased from 23 per cent in 2017-18 to just 17 per cent in 2019 (see figure 2), with deaths associated with HAI also significantly falling (see table 1).

More reliable POCT has also allowed better use of Addenbrooke’s limited side room resources; having a rapid diagnostic test at the gateway of the hospital has meant that suspected flu patients can be isolated appropriately on admission. In addition, the new point-of-care test highlighted that bed space cleaning protocols could be made more efficient with faster turnaround of results.

Potential in other areas

On the back of this success, Addenbrooke’s POCT team is considering whether ED is the only location appropriate for this device, and may expand to other clinical areas within the trust in the future.

Summary

The GeneXpert System has provided Addenbrooke’s with an efficient and reliable means to accurately diagnose flu and RSV, which has had a positive impact on both turnaround times and local decision making for effective patient management, while also helping to reduce the costs associated with winter outbreaks. Figures already show significant improvements, with cases of hospital-acquired influenza alone decreasing from 23 per cent in 2018 to 17 per cent in 2019. The ED has benefitted greatly from point-of-care molecular diagnostics testing; this is the first time that a rapid microbiology test has been successfully deployed there, and it has been very well received. Providing doctors with a result for patients who are still under their care has given them the confidence to discharge patients who would otherwise have been admitted based on diagnostic uncertainty around their symptoms. This has undoubtedly helped to reduce admissions at a time of unparalleled bed pressures in the NHS, and several similar initiatives are in the pipeline for other departments to continue to improve patient care across the trust in the near future.

 

 

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