How can testing support influenza diagnosis

1. Using Influenza POCT to
Improve Patient Care and
Hospital Efficiency
Emma Meader PhD FRCPath
Clinical Scientist ¦ The Specialist Virology Centre
The Norfolk & Norwich University Hospital NHS
Foundation Trust

2. Why we chose the Liat system
High sensitivity and specificity
Uses nasopharyngeal swab
Hands on time under 2 min
Results in 20 min (‘flu A and B)
Capacity to print results
Possibility for IT interface

3. Hospital areas that can benefit from ‘flu POCT
Accident and emergency
Urgent care centres
Pathology lab
Haematology clinic
Delivery suiteChildren’s assessment unit Acute medical wards
Critical Care
IP&C teams and
site practitioners

4. 2017/2018 season: evaluation in A&E

5. 0
5
10
15
20
25
9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 23 24 25 26 27 1 2 3 4 5 6 7 8 9
Date
INFLUENZA POCT IN USE
MEAN 2.7
MEAN 12.3
A cluster of cases from an AMU admission (which didn’t participate in the trial)
Bed management and risk of nosocomial transmission

6. Increased frequency of discharge after assessment
Influenza pre-
POCT
Influenza
post-POCT
Number of
admissions
saved
Percentage of patients admitted 42 39 1.14
URTI pre-POCT URTI post-
POCT
Number of
admissions
saved
Percentage of patients admitted 17 12 7.45
= 45 admissions avoided over a typical season…….…likely many more than this

7. Length of Stay
0.0 1.0 2.0 3.0 4.0 5.0 6.0
MEAN
MEDIAN
MODE
Pre-'Flu POCT
Influenza negative Influenza positive
0.0 2.0 4.0 6.0
MEAN
MEDIAN
MODE
During 'Flu POCT Use

8. Our current strategy
• 1 Liat in accident and emergency
• 1 Liat in the acute medical unit
• 1 Liat in the haematology clinic
• Site practitioners also trained
• Other areas use routine daily lab testing

9. Challenges: our experience from this season
Funding Availability of staff to prepare, implement and support ‘flu POCT
Some areas not great at knowing when to test
Stock management and multiple batches Result access
Maintaining training records
Influenza typing
Surveillance reporting Workload in testing areas
Hospital escalation policies need to include POCT use Visitors and staff
….then testing everyone
All areas want one
Assessing the risk of transmission to others

10. The benefits!
• Patient experience
• Can support decision to discharge after assessment
• More efficient use of side rooms
• Ward & ops staff (generally) love it!
• Financial savings likely

11. What is the impact in
£££ over a ‘flu season?
• Admissions avoided: 45 = £30,870
• Bed days saved: 743.75 = £104,125
• Blocked beds saved: 66 = £7,560
• Total = £142,555
• Minus cost of kits…………
Not included: rational use of Tamiflu; possible
reduction in staff exposure/sickness; reduced
exposure to other nosocomial infections.