A comprehensive test which rapidly diagnoses the cause of people’s winter lung illnesses in A&E is enabling more targeted treatment and reducing the number of people needing hospital admission – according to new research presented at the British Thoracic Society Winter Meeting today (Thursday 6th December 2018)
Researchers from West Hertfordshire Hospitals NHS Trust will tell delegates that test results are on average 7 times faster than normal because trained staff within A&E conduct the test - rather than samples being sent to the laboratory.
The study team believe this is helping staff to make critical decisions far earlier on which treatment to give and whether to hospitalise patients.
West Hertfordshire Hospitals NHS Trust employed ‘respiratory point of care testing’ (R-POCT) which:
- involves the genetic analysis of a swab taken from the patient’s nose, mouth or throat which isolates the specific bugs which may be causing the patient’s lung illness. And in analysing 18 viruses and 4 atypical bacteria, it is a far more comprehensive test than many others that often just look for ‘flu
- is delivered by nurses and doctors in the emergency department – with the test results being delivered after 6.5 hrs (on average) from when the patient was admitted to A&E, compared with 44.4hrs when sent to the laboratory
The research studied 1,075 patients with respiratory or general ‘flu-like symptoms who received R-POCT at the Hospital between 15 January – 1 May 2018. Initial in-depth data analysis was undertaken on the outcomes of 387 patients in the study.
The results were as follows:
- 6 in 10 patients had a respiratory virus – and over half (56%) of these had influenza. The research was conducted during a season with high ‘flu rates and the researchers believe that numbers are likely to be significantly lower outside these seasons, but the ability to identify other viral causes of lung illness is key to providing effective treatment - as they can have an impact similar to that of influenza, especially in those with an underlying respiratory condition
- 121 patients were identified as being ‘lower risk’ - potentially suitable for discharge home without antibiotics – after further clinical examination. They had a respiratory virus, but showed low inflammation levels in the blood and had a normal chest x-ray
- Of these – around 20% did in fact avoid hospital admission and nearly half (60) didn’t go on to receive antibiotics at all
- Of 50 influenza cases, the 22 who were tested in the emergency department with R-POCT did not need to move beds - as they had already been placed in appropriate wards to minimise any infection risk to vulnerable patients
Dr Kay Roy, Respiratory Medicine Consultant at West Hertfordshire Hospitals NHS Trust, and member of the British Thoracic Society said:
“During Winter, A&E departments have to cope with a surge of patients with lung infections. The key issue is to rapidly find out what is causing and driving these illnesses.
This comprehensive test is being delivered very quickly and closer to the patient – which allows us to make rapid, informed decisions about treatment and whether admission to hospital is needed.
Our research shows that the test, working alongside other diagnostic methods, can lead to a reduction in unnecessary antibiotic use.
It also allows us to diagnose ‘flu at the front door rather than on the hospital ward – so we can quickly find the best place in the hospital for a patient’s care – minimising the potential risk of transmission of ‘flu to vulnerable patients.”
At a national level, pneumonia and ‘flu caused 269,313 emergency hospital admissions in the UK in 2016/17 which cost the NHS an estimated £1 billion.
For more information prior to the British Thoracic Society Winter Meeting (i.e. before Wednesday 5th December 2018):
Charlotte Sutton: t: 07958 279240
Alessandra McKenna t: 07967 976652
Ed Gyde t: 0780 9574801
During the British Thoracic Society meeting (from Wednesday 5th to Friday 7th December 2018):
Please contact the BTS news media office on t: 020 7798 4543 / 020 7798 4541 or the mobile numbers above.
Note to Editors:
The British Thoracic Society is the UK’s professional body of respiratory specialists. The Society seeks to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care. A registered charity, it has about 3,500 members including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest.
The British Thoracic Society Winter Meeting takes place between 5-7 December 2018 at the Queen Elizabeth II Conference Centre in Westminster, London.