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BMJ Open. 2019 Aug 8;9(8):e030104. doi: 10.1136/bmjopen-2019-030104.
Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: a retrospective observational study across six Australian hospitals.
Wabe N1, Li L1, Dahm MR1, Lindeman R2, Yimsung R2, Clezy K3, Thomas J1, Varndell W4, Westbrook J1, Georgiou A1.
Author information
1 Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia. 2 Clinical Operations, NSW Health Pathology, Chatswood, New South Wales, Australia. 3 Infectious Diseases Department, Prince of Wales Hospital, Randwick, New South Wales, Australia. 4 Emergency Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Abstract
OBJECTIVE:
A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes.
DESIGN:
Retrospective observational study.
SETTING:
Linked ED and laboratory data from six EDs in New South Wales, Australia.
PARTICIPANTS:
Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient's ED arrival to time of sample receipt at the hospital laboratory.
OUTCOME MEASURES:
ED length of stay (LOS), >4 hour ED LOS and having a pending RMDT result at ED disposition.
RESULTS:
A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133-349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8-26.1; p<0.001), a 51% increase in the likelihood of staying >4 hours in ED (OR, 1.51; 95% CI, 1.41 to 1.63; p<0.001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04; 95% CI, 1.02 to 1.05; p<0.001) after adjustment for confounders.
CONCLUSION:
The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.
? Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS:
diagnostic microbiology; infection control; molecular diagnostics
PMID: 31399462 DOI: 10.1136/bmjopen-2019-030104
Free full text
Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: a retrospective observational study across six Australian hospitals.
Wabe N1, Li L1, Dahm MR1, Lindeman R2, Yimsung R2, Clezy K3, Thomas J1, Varndell W4, Westbrook J1, Georgiou A1.
Author information
1 Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia. 2 Clinical Operations, NSW Health Pathology, Chatswood, New South Wales, Australia. 3 Infectious Diseases Department, Prince of Wales Hospital, Randwick, New South Wales, Australia. 4 Emergency Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Abstract
OBJECTIVE:
A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes.
DESIGN:
Retrospective observational study.
SETTING:
Linked ED and laboratory data from six EDs in New South Wales, Australia.
PARTICIPANTS:
Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient's ED arrival to time of sample receipt at the hospital laboratory.
OUTCOME MEASURES:
ED length of stay (LOS), >4 hour ED LOS and having a pending RMDT result at ED disposition.
RESULTS:
A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133-349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8-26.1; p<0.001), a 51% increase in the likelihood of staying >4 hours in ED (OR, 1.51; 95% CI, 1.41 to 1.63; p<0.001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04; 95% CI, 1.02 to 1.05; p<0.001) after adjustment for confounders.
CONCLUSION:
The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.
? Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS:
diagnostic microbiology; infection control; molecular diagnostics
PMID: 31399462 DOI: 10.1136/bmjopen-2019-030104
Free full text