Impact of a PCR point of care test for influenza A/B on an acute medical unit in a large UK teaching hospital: results of an observational, pre and post intervention study

Abstract

Background Influenza viruses is a leading cause of acute respiratory infection, placing a significant burden on healthcare. To reduce hospital transmission, patients clinically suspected of having influenza are isolated and offered empirical antiviral treatment. Here we report the use of a point of care test (POCT) for influenza viruses in an acute medical unit (AMU) at Queen Elizabeth Hospital Birmingham for patients presenting with influenza-like illness. Methods A PCR POCT was installed on AMU in Dec 17 – Mar 18 (period 2) and used to test any patient with influenza-like illness. We conducted an evaluation against influenza virus’s data collected between Dec 16–Mar 17 (period 1) where no POCT was used. Four outcomes were measured: length of stay, oseltamivir utilisation, time to isolation and in-hospital cases of influenza viruses. Results There were 51 confirmed influenza virus cases in period 1 vs 666 in period 2. During period 2, the length of stay of patients presenting with influenza-like illness (2.4 vs 7.9 days) and time to isolation from receipt of a positive result (0.09 vs 1.26 days) was significantly shorter. The time to initial receipt of antivirals for patients with influenza virus was significantly quicker in period 2 (0.59 vs 1.1 days) and the total number of influenza virus cases identified after 72 h of admission was significantly lower (9% vs 51%). Discussion Following introduction of the POCT, there was an increase in appropriately targeted oseltamivir prescribing, shorter time to isolation, proportionally less post-72-h influenza virus cases and a reduction in length of stay of patients presenting with influenza-like illness. Conclusions Routine use of POCTs for viruses should be introduced into diagnostic pathways for acute respiratory illness, especially at the front door of hospitals.

Appropriate Use and Future Directions of Molecular Diagnostic Testing

“…CLIAwaived means that these tests can be performed outside of a laboratory and by non-laboratory staff such as nurses. Studies of these platforms have shown clinical impact for influenza detection in both the inpatient and ambulatory settings [53,54]. In a prospective, single-season study of urgent care centers connected to their health system, Benirschke et al found a significant reduction in the use of antibiotics for those who tested positive for influenza by a POC molecular test compared to those who tested positive by a POC antigen test [54].…”

Point-of-Care Testing for the Emergency Department Patient: Quantity and Quality of the Available Evidence

“…However, in the viral influenza group, 7 studies 3,4,11,14,19,20,22 showed a significant decrease in ED-LOS, with 4 showing no significant change in ED-LOS. 6,12,18,21 The remaining 10 studies 5,[7][8][9][10]13,[15][16][17]23 did not report any findings related to ED-LOS.…”

Syndromic panels or the panels' syndrome? A perspective through the lens of respiratory tract infections: author's response

“…Among paediatric patients, the use of rapid tests demonstrated a decrease in emergency department length of stay, a reduction in further diagnostic tests, and an increase in the appropriate use of antibiotics and antivirals [5]. Similarly, a more appropriate use of oseltamivir, shorter time to isolation, and a reduction in length of stay were also shown among adults [6]. Nevertheless, considering the methodological limitations, we believe that the conclusions driven by the post hoc analysis of the ResPOC study regarding the impact of turnaround time on antibiotic use and length of stay should be interpreted with caution [7].…”