BackgroundThe field of medicine is rapidly becoming digitised, and in the process passively amassing large volumes of healthcare data. Machine learning and data analytics are advancing rapidly, but these have been slow to be taken up in the day-to-day delivery of healthcare. We present an application of machine learning to optimise a laboratory testing programme as an example of benefiting from these tools.MethodsCanterbury District Health Board has recently implemented a system for urgent lab sample processing in the community, reducing unnecessary emergency presentations to hospital. Samples are transported from primary care facilities to a central laboratory. To improve the efficiency of this service, our team built a prototype transport scheduling platform using machine learning techniques and simulated the efficiency and cost impact of the platform using historical data.ResultsOur simulation demonstrated procedural efficiency and potential for annual savings between 5% and 14% from implementing a real-time lab sample transport scheduling platform. Advantages included providing a forward job list to the laboratory, an expected time to result and a streamlined transport request process.ConclusionThere are a range of opportunities in healthcare to use large datasets for improved delivery of care. We have described an applied example of using machine learning techniques to improve the efficiency of community patient lab sample processing at scale. This is with a view to demonstrating practical avenues for collaboration between clinicians and machine learning engineers.

A previously well 16-year-old boy presented to the emergency department with fever, rigor, and pain in his chest, neck and dorsal right hand. The illness had begun 10 days earlier with a sore throat, which was reviewed at an after-hours walk-in clinic and presumed to be viral. He remained unwell and began to experience neck pain, and so presented to the emergency department two days later. Following a normal lumbar puncture, he was discharged home with a provisional diagnosis of Epstein-Barr virus. A throat swab was taken during this visit that grew group G Streptococcus. Treatment was not given as per hospital policy for this type of infection.Two days later he returned to the emergency department with persistent fever, rigor, neck pain and pleuritic chest pain. The sore throat had resolved, but his right hand had become swollen and painful.The patient appeared clammy and pale despite normal vital signs. His neck was tender to the left of the trachea, along the line of the sternocleidomastoid; there were no signs of meningism. His throat appeared inflamed, but there was no tonsillar exudate. His cervical lymph nodes were tender and enlarged. There were no rashes or peripheral stigmata of infective endocarditis. Cardiorespiratory and abdominal examination were normal. The dorsum of the right hand was tender and swollen, and had reduced range of motion secondary to pain.Initial investigations showed an inflammatory response, with C-reactive protein 106 (normal 0-5) mg/L and leukocyte count 13.8 (normal 4.0-11.0) × 10 9 /L. Liver tranaminase levels were mildly elevated, the international normalized ratio was 1.3 and the albumin level was 23 (normal 34-48) g/L. Renal function and electrolytes were normal. A chest radiograph showed numerous right-sided pulmonary nodules. The right wrist joint was aspirated, but no fluid was obtained. Computed tomography of the neck and chest showed abnormal filling of contrast in the left internal jugular vein extending from C3 to the thoracic inlet ( Figure 1); there were no drainable abscesses in the neck. There were multiple cavitating lesions within both lungs and a small associated empyema (Figure 2).The patient was given empirical treatment with intravenous piperacillin-tazobactam and clindamycin based on a radiologic diagnosis of Lemierre syndrome, pending the results of cultures and sensitivities. He was transferred to the high dependency (intermediate care) unit because of severe sepsis and low urine output. Blood cultures later grew Fusobacterium necrophorum.Despite treatment, the patient continued to have temperature spikes and his right hand became progressively more painful and swollen. Ultrasonography confirmed a superficial collection in the soft tissue of the dorsum of the right hand, which required two surgical washouts and drain insertion. Ultrasonography of the neck, performed to investigate increasing neck swelling, showed that the thrombus had extended to completely occlude the left internal jugular vein. Anticoagulation with warfarin, with bridging enoxaparin, ...

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VariablesEuropean Maori P value