Diagnostics
Faster diagnostics key to improving sepsis care
The bioMérieux UK Sepsis Summit recently raised awareness of diagnostic strategies that can help improve outcomes for patients with sepsis. During the conference, the Royal Berkshire NHS Foundation Trust shared an insight into a trial of innovative technology which reduced time to identification of pathogens – optimising antibiotic prescribing, reducing length of hospital stay, and improving patient outcomes.
Innovative solutions for sepsis diagnosis were high on the agenda at the UK Sepsis Summit – with valuable insights provided by hospital Trusts into the latest improvement initiatives. Hosted by bioMérieux, at the University of Nottingham, the event provided an opportunity for multiple stakeholders engaged within the sepsis patient pathway to come together and share best practice. Discussions held at The UK Sepsis Summit highlighted that a collaborative, integrated and optimised pathway is crucial to enable informed clinical decision making and improved patient pathways. But could novel solutions in syndromic testing also take patient care to the next level? During the two-day event, Olubunmi Martindale-Sheldon, Directorate Manager, Pathology and Pharmacy, Royal Berkshire NHS Foundation Trust, delivered a presentation titled: “Innovative solutions for sepsis diagnosis and treatment – leveraging the potential of BioFire Technology”. Her presentation included discussion of the blood culture pathway, critical control points, and the challenges with sepsis diagnosis and treatment. Olubunmi also shared the findings of a recent trial of BioFire, including some success stories where the management of patients had been optimised through the adoption of the technology.
Olubunmi explained that the Royal Berkshire
Hospital is a ‘spoke site’, which meant that the microbiology lab was situated off-site at Wexham Park Hospital. This inevitably presented some challenges. As the lab was off-site, the turnaround time for identification of pathogens with antimicrobial sensitivity was between one and five days (five-day turnarounds were not uncommon). Some of the issues were as a consequence of transport. “The service hours for the main lab are 7am
to 8pm, Monday to Friday, and 7am to 5pm on Saturday and Sunday, so it is not open 24/7. There are a number of limitations in terms
BioFire TORCH, would provide an on-site, 24/7 service, capable of ensuring identification in in just over an hour. The service would be provided by trained technicians in the Blood Sciences Rapid Response Lab with oversight from biomedical scientists in collaboration with the microbiologist at the Wexham Park site. “It is not just about using the technology. You must ensure the governance is in place, so that the results are trusted,” commented Olubunmi. A business case was presented to the Board, with input from the clinical leads, and the technology was approved for a six-month trial. The pilot aims included the following:
of using the lab, therefore. This is significant as there is a potential for increased risk of mortality – risk of death increases 1.2-fold each day of delay in microbiological diagnosis,” Olubunmi pointed out. She added that delay in diagnosis also results
in increased hospital length of stay, while patients are put on empirical antibiotics, which may not work effectively for the infection that they have. This ultimately impacts on flow and discharges. Inappropriate use of antibiotics can also result in side effects and leads to poor patient experience and outcomes. Giving antibiotics to patients who do not need them is also undesirable in terms of antimicrobial resistance, while delay in diagnosis further impacts hospital resources. If the hospital does not have a diagnosis for the infection, the patient may need to be isolated which can cause pressures, as the hospital has limited side rooms. Delays in diagnosis can also lead to escalation and patient transfers to level 2/3 care (HMU/ICU) – an expensive and limited resource.
The solution The adoption of technology to resolve these issues was key to driving improvement at the Royal Berkshire Hospital. The proposed solution,
l Compare BioFire technology with the conventional laboratory method
l Review the impact on the patient pathway l Determine whether the following three primary metrics are achievable: l Reduction in time to identify the pathogen (improved process)
l Reduction in time to effective therapy (improved patient outcome)
l Blood culture contamination rate <3% (reduced wastage)
Pilot findings A total of 183 patients were tested using BioFire between January and June 2022. The majority were from the emergency department. The pilot found:
l Improved turnaround time – sample collection to pathogen identification.
l BioFire time to result was around four hours compared to around 27 hours for the centralised offsite laboratory.
l Using BioFire, the average reduction in time to pathogen identification was 17 hours per patient.
The blood culture results turnaround times can be seen in Fig 1. There was a high level of agreement between the two methods (175/183; 95.63%) (Fig 2). In terms of appropriate and
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