Clinical impact of rapid influenza PCR in the adult emergency department on patient management, ED length of stay, and nosocomial infection rate

Abstract

Background Seasonal influenza causes significant morbidity and mortality and incurs large economic costs. Influenza like illness is a common presenting concern to Emergency Departments (ED), and optimizing the diagnosis of influenza in the ED has the potential to positively affect patient management and outcomes. Therapeutic guidelines have been established to identify which patients most likely will benefit from anti‐viral therapy. Objectives We assessed the impact of rapid influenza PCR testing of ED patients on laboratory result generation and patient management across two influenza seasons. Methods A pre‐post study was performed following a multifaceted clinical redesign including the implementation of rapid influenza PCR at three diverse EDs comparing the 2016‐2017 and 2017‐2018 influenza seasons. Testing parameters including turn‐around‐time and diagnostic efficiency were measured along with rates of bed transfers, hospital‐acquired (HA) influenza, and ED length of stay (LOS). Results More testing of discharged patients was performed in the post‐intervention period, but influenza rates were the same. Identification of influenza‐positive patients was significantly faster, and there was faster and more appropriate prescription of anti‐influenza medication. There were no differences in bed transfer rates or HA influenza, but ED LOS was reduced by 74 minutes following clinical redesign. Conclusions Multifaceted clinical redesign to optimize ED workflow incorporating rapid influenza PCR testing can be successfully deployed across different ED environments. Adoption of rapid influenza PCR can streamline testing and improve antiviral stewardship and ED workflow including reducing LOS. Further study is needed to determine if other outcomes including bed transfers and rates of HA influenza can be affected by improved testing practices.

Nosocomial influenza in a pediatric general ward: Effects of isolation and cohort placement of children with influenza

“…However, the significant usefulness of early antiviral therapy for inpatients with influenza and PCR-based POCT for reducing nosocomial transmission of influenza has not been defined. 9,10,23,24 In this study, we found comparable clinical manifestations and outcomes between children with CA influenza and children with HA influenza. Previous reports have shown inconsistent results regarding increased clinical severity in patients with HA influenza compared to those with CA influenza.…”

“…However, the significant usefulness of early antiviral therapy for inpatients with influenza and PCR-based POCT for reducing nosocomial transmission of influenza has not been defined. 9,10,23,24…”

Hospital-acquired influenza in the United States, FluSurv-NET, 2011–2012 through 2018–2019

“…31 Early rapid detection of influenza virus infection with implementation of early treatment and infection control measures has been shown to reduce hospital length of stay, to lower hospital occupancy, and to decrease the spread of HA influenza. 2,33,34 This study had several limitations. Influenza testing within FluSurv-NET is clinician-driven or based on different facility-based testing policies, which likely resulted in an underestimation of HA influenza cases, particularly among those who present with nonrespiratory symptoms or asymptomatically.…”

Impact of Fast SARS-CoV-2 Molecular Point-Of-Care Testing on Patients’ Length of Stay in an Emergency Department

“…Altogether, these studies emphasize that rapid detection of respiratory viral infections directly in emergency departments could improve patient management and bed occupancy. Reducing the time of infected individuals in emergency wards could also limit the risks of nosocomial transmission ( 15 , 17 , 18 ). A recent study using another molecular POCT showed that its implementation in the ED was associated with a significant reduction in the rate of hospital-acquired COVID-19 cases ( 19 ).…”