Diagnostics
including ineffective treatments that may worsen symptoms or even advance the disease. The clinical repercussions of a wrong or delayed diagnosis must be taken into consideration in the economics of choosing a testing solution for respiratory viruses. Hospital laboratories, like so many other healthcare services, are already under significant strain due to a growing workload, chronic understaffing and budget cuts. Dealing with a sudden increase in respiratory tests during the winter months can therefore be challenging and may lead to backlogs. Traditional diagnostic testing performed in a laboratory can also lead to unavoidable delays in results, potentially prolonging hospital stays and increasing both the cost of care and the risk of disease transmission between patients. The average cost of hospitalisation from influenza is predicted to be upwards of £3,000, so diagnosing or ruling out the virus early could lead to more effective patient management that would offer potential cost savings for Trusts.7
The situation is further complicated
by the fact that healthcare funding has been greatly restricted since 2019 – decreasing by an average of 3 % between the 2019/20 and 2024/25 financial years8
– and the introduction of new
antiviral therapies that are most effective when given early. This means that healthcare providers must increase their respiratory testing capacity in the face of increasingly limited financial resources.
Fast and reliable diagnostics where it’s needed most These multiple pressures emphasise the crucial need for fast and efficient diagnostic tests that can accurately differentiate between the respiratory illnesses that share overlapping symptoms, such as congestion, coughing, malaise, myalgia and fever. Distinguishing between the causative agents – particularly
SARS-CoV-2, influenza A/B and RSV – is essential, not only for providing appropriate patient care, but also for effectively containing outbreaks of these highly contagious illnesses. The pandemic provided an opportunity and impetus to review the correct care pathways for numerous indications and patient groups, and has highlighted respiratory virus testing in central laboratories as a bottleneck to rapid care. Hospitals therefore looked towards POC or near-patient testing for respiratory viruses as a solution to provide rapid and accurate results, dramatically improving the average time-to- result, while alleviating the pressure on central laboratories for these urgent tests. POC testing has long been used in hospital environments for routine diagnostics, such as urine testing and blood gas analyses. It offers high sensitivity and specificity, provides clinical staff with a
Likely infection rates over the coming winter remain uncertain, but elevated instances of influenza and SARS-CoV-2 in the southern hemisphere suggest a challenging season ahead, underscoring the urgent need for rapid and accurate respiratory testing.
wider investigative window, and allows the decentralisation of laboratory-standard diagnostics. Coupled with recent advances in automation and the robustness of analytical technologies, this supports efficient patient management and enables healthcare systems to meet growing testing demands in the face of financial pressures and staff shortages. Establishing a POC PCR testing pathway may
be perceived as more expensive than using traditional laboratory testing, but the initial outlay can be offset against clear cost savings to the organisation as a whole. These savings primarily result from improved workflows, quicker discharge of uninfected patients and reduced bed blocking, as well as protection of both the workforce and patients against hospital-acquired infections.9,10
Transforming triage with multiplex assays Introducing PCR-based testing at the POC has the power to revolutionise traditional healthcare models, with the aim of improving the convenience and efficiency of patient care pathways to ultimately minimise delays and enhance overall care. To achieve this, a POC device must be sensitive, specific and reliable without requiring additional reflex tests, especially when time is critical. Multiplexed PCR assays – such as the Xpert Xpress CoV-2/Flu/RSV plus from Cepheid – provide definitive respiratory diagnostics in record time to complement and support laboratory investigations, particularly during periods of higher demand and out of hours. These assays offer a holistic approach by enabling the simultaneous detection of multiple pathogens from a single sample, simplifying the diagnostic procedure and removing the need for multiple swabs. Multiplexed PCR assays for SARS-CoV-2, influenza A/B and RSV have been shown to be highly sensitive and accurate in POC settings, with a comparable performance to individual tests for each virus,9
but with
the added benefit of simultaneous testing. The latest generation of high quality tests are designed to cover an extremely broad range of genetic variation without compromising
December 2024 I
www.clinicalservicesjournal.com 21
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