Evaluating the Benefits of Viral Respiratory Panel Test in the Reduction of Emergency Department Throughput Time for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Introduction There has been a widespread antibiotic prescription in the Emergency Department (ED) among patients presenting with acute exacerbation chronic obstructive pulmonary disease (AECOPD) irrespective of the causative agent of the disease. The viral respiratory panel (VRP) test is designed to detect viral pathogens in the respiratory tract, which may contribute to the exacerbation of chronic obstructive pulmonary disease (COPD), as the upper and lower respiratory tract infections are caused by a broad range of microbes and not only bacteria. The aim of this study is to weigh the benefits of obtaining a VRP in patients presenting with isolated symptoms pertaining to well-defined criteria of an AECOPD with preexisting COPD or reactive airway disease to find out how such test impacts patient throughput time in the ED and also investigate how obtaining a VRP affects the use of antibiotics in this patient population. It is important that ED physicians accurately diagnose the main cause of AECOPD to help optimize the use of health care resources, including antibiotics, antivirals, inpatient, and ED beds. VRP testing must be taken into consideration as it helps eliminate the need of administering antibiotics to every patient who presents to the ED with AECOPD. Design and method This is a case-control observational study using retrospective chart review to obtain patients’ data from our hospital data warehouse. Data on patients with the primary diagnosis of AECOPD in the past two years were retrieved. A comparison between those who had VRP on arrival in the ED and those who did not have a VRP obtained was performed. We also compared ED throughput time for patients with AECOPD who received antibiotics to those who did not receive antibiotics. Only patients between the ages of 18 and 64 were included in the study. Patients with other preexisting health conditions such as cardiac diseases, neurological problems, and abdominal complaints were excluded. Patients who required hospitalization and pregnant patients were excluded from the study. Results We collected the data of 340 patients who met the study criteria. Of the 340 patients enrolled, 65 (19%) received the VRP test and 275 (81%) did not receive VRP test. Among the 65 patients who received the VRP test, 45 (70%) had a virus etiology detected and reported in the ED (p=0.001). Also, 138 (50.2%) did not receive VRP test and were not given antibiotics, and 137 (49.8%) did not receive VRP test but were treated with antibiotics; 11 patients received antibiotics despite haven tested positive to a virus. The result showed that those who received antibiotics with no VRP test on arrival in the ED had a shorter throughput time compared to patients who did not receive antibiotics but received VRP test. Conclusion The study is a quality improvement study to help determine the efficacy and appropriateness of ordering a VRP prior to ED disposition and the impact of overall ED throughput time fo...

Effects of Ambient Air Pollutants on Hospital Admissions among Children Due to Asthma and Wheezing-Associated Lower Respiratory Infections in Mysore, India: A Time Series Study

“…The viral respiratory panel (VRP) test is designed to detect viral pathogens in the respiratory tract, which may contribute to the exacerbation of chronic obstructive pulmonary disease (COPD), as the upper and lower respiratory tract infections are caused by a broad range of microbes and not only bacteria [ 62 ]. Opara et al have discussed the advantages of VRP tests in acute exacerbation of COPD (AECOPD) among 18–65-year-old adults.…”

Epidemiology of Adenovirus Infection in Hospitalized Children in the United States From 1997 to 2019

“…[19][20][21] The rationale for the increased use of rapid diagnostic testing is the rapid identification of respiratory viral pathogens leading to decreased antibiotic use and reduced unnecessary tests. [22][23][24] Another reason for increased prevalence could be due to the methods used to detect viral pathogens. Older methods such as viral cultures and antigen detection by immunofluorescence are less sensitive compared to currently used polymerase chain reaction-based multiplex assays.…”