Download Randy Poelman , Johan van der Meer , Coretta van Leer

POINT-OF-IMPACT TESTING IN THE EMERGENCY DEPARTMENT:
DIAGNOSTICS FOR RESPIRATORY VIRAL INFECTIONS
Randy
Poster ID: S35
1
Poelman ,
1Department
Johan van der
2
Meer ,
Coretta van
1
Leer-Buter ,
Annelies
1
Riezebos-Brilman ,
Alex
1
Friedrich
and Bert
1
Niesters
of Medical Microbiology, Division of Clinical Virology; 2Emergency Department, The University of Groningen, University Medical Center Groningen, the Netherlands
Background
Objective
Methods
Molecular diagnostics for infectious diseases is increasingly
important in a clinical setting for both disease management
and infection control. New highly sensitive and specific
tests become readily available due to the shifting trend
from single to multiplex testing, as well as from centralized
to decentralized Point-Of-Impact Testing (POIT).
With a critical window of opportunity for innovations within a hospital setting,
we aimed to assess the value of POIT for respiratory viral diagnostics at the
emergency department, by implementing an adequate diagnostic policy. This
will affect the laboratory hands-on time and the total turnaround time which
is related to adequate therapy, infection control measures and cost
redundancy.
For the improved hospital broad diagnostic policy, the emergency
department (ED), the department of medical microbiology and several
clinical wards were actively involved. The BioFire respiratory panel
(bioMerieux) was implemented and we extended our service from 08h to
22h, 7 days a week during the respiratory season from early December
2014 to early April 2015.
We created a hospital broad model to represent the cost-effectiveness and
measured the (clinical) benefits and costs for a two months period.
Improved diagnostic policy
The AID stewardship model
Active involvement of the multi disciplinary stakeholders
improved open discussion and has shown to be important
for creating hospital-broad awareness and support.
Improved diagnostic policy involves not only an
Antimicrobial Stewardship Program (ASP), but also an
Infection prevention Stewardship Program (ISP) and a
Diagnostic Stewardship Program (DSP). Besides, since the
sensitivity of commercial assays approach the quality of
Laboratory Developed Tests, we introduced the €hr
concept (comparable with kWh), to represent the value of
POIT in patient care.
Patients with a suspected respiratory viral infection appearing at the
emergency department during the respiratory season:
The improved clinical outcome resulted in:
 Less unnecessary isolations
 Less nosocomial infections
Sample collection in early triage and dispatch to lab
 Mean turnaround time from 19 hours to 1 hour
 No incremental costs
Fig 1b
Figure 1a Multi stakeholder platform, including the ASP, ISP and DSP, with
effective diagnostics as a solid base.
Figure 1b Optimal diagnostic policy includes: quality, time and cost, merged
in the €hr concept.
A
that improved the patient outcome. Besides, it helps to keep
control of antibiotic resistance.
Figure 2 Routing as intended in the improved diagnostic policy
Fig 1a
The total turnaround time decreased significantly to a mean of 3
hours, which contributed to:
 Improved (preliminary) diagnosis
 More adequate therapy
€ 175,000*
€ 40,000*
I
Furthermore, cohorting of patients leads to a huge improved
bed management.
A slight increase of costs at the division of clinical virology due to:
 Extended service
€ 10,000
 Increased number of tests performed
€ 40,000*
D
* Preliminary calculations
Performing the random access commercial test
 Mean turnaround time from 17 hours to 2 hours
 Laboratory hands-on time: from 5 hours to 5 minutes
Financial benefit per patient tested: €135 * 33h = 4,455 €hr
Figure 3 hospital broad benefits exceeded incremental costs for POIT diagnostics
Conclusions
Our co-creative approach resulted in a new hospital broad
policy, which includes an optimal implementation of POIT
for the detection of respiratory viral infections.
This policy increases the value of molecular diagnostic testing for respiratory
viruses with respect to patient safety, therapy, and infection control, which is
reflected by applying the AID stewardship model and by combining time and
cost in the €hr concept.
Hospital broad financial benefits in only the first two
months were estimated to be at least €160,000, which
makes the implementation of POIT in the respiratory
season to be very cost-effective.
Contact:
medicalmicrobiology.eu