As we enter the long anticipated period of summer holidays, it may seem premature to be thinking about winter planning but this is exactly what our colleagues in the NHS are doing. Through the months of October to March, winter planning aims to boost capacity and resilience of NHS services, particularly those associated with emergency departments (ED) and ambulance provision.
The importance of winter planning in the NHS
Winter planning explores how to:
- better support people in the community,
- maximise bed capacity and support ambulance services,
- ensure timely discharge and support people to leave hospital when clinically appropriate, and
- reduce the number of patients waiting in ED for a suitable bed, ambulance handover delays, and ambulance response times.
During the winter months, the seasonal increase in respiratory infections, such as coughs/colds, sore throats, and ‘influenza-like illnesses’ (ILI) exert considerable pressure on healthcare services. In preparation, healthcare “systems should actively consider establishing Acute Respiratory Infection (ARI) hubs as part of preparing for managing increased ARI in the community” (ref: Going further on winter resilience plans).
The rise of rapid multiplex PCR testing: A new approach to molecular diagnostics
Another approach to support resilience of services during the winter respiratory season could involve the introduction of rapid and/or point-of-care testing for respiratory viruses in emergency and acute hospital settings; however, until recently, the clinical impact of rapid multiplex PCR testing for respiratory viruses had not been systematically assessed. In May 2023, Clark et al. 2023, systematically reviewed the evidence.
Twenty-seven studies were eligible for inclusion in the review, comprising 17,321 patient encounters. Rapid multiplex PCR tests eligible for inclusion were those offering a syndromic diagnostic approach (defined in this review as having 10 or more targets) and included a number of different sample-to-answer multiplex PCR platforms.
Key findings from the 2023 study: Benefits and limitations of rapid testing
Here is a brief synopsis of the key findings:
- Time-to-result: rapid multiplex PCR tests were associated with a significant reduction in time to results compared with routine testing (−24.22 h, 95% CI −28.70 to −19.74 h, I2 98.7%).
- Length of hospital stay (LOS): significantly shorter among patients who were tested using a rapid multiplex PCR test compared with routine testing (MD −0.82 days, 95% CI −1.52 to −0.11 days, I2 91.9%).
- Appropriate use of neuraminidase inhibitors (NAI) and infection prevention control (IPC): patients who tested positive for influenza were 1.25 times more likely to be appropriately treated with NAIs (RR 1.25, 95% CI 1.06–1.48, I2 67.7%) and 1.55 times more likely to receive appropriate IPC when tested with rapid multiplex PCR tests compared with routine testing (RR 1.55, 95% CI 1.16–2.07, I2 70.4%). Interestingly, no study reported IPC measures for respiratory syncytial virus (RSV) or other non-influenza viruses.
- Cost-related outcomes: overall cost savings due to shorter LOS were reported in the multiplex PCR test group compared with the routine testing group, as were lower medication costs with antivirals or antibiotics. One study reported favourable results for the multiplex PCR test group compared with the routine testing group in terms of labour costs, costs for reagents, run controls, external quality control, depreciation and maintenance of equipment, and a 20% overhead.
Conversely, rapid multiplex PCR testing for respiratory viruses was not shown to have a significant difference on antibiotic use, proportion and duration, or mortality:
- No significant difference in antibiotic use (RR 0.92, 95% CI 0.78–1.09, I2 97.4%) or duration of antibiotic use (MD −0.41, 95% CI −1.11 to 0.29 days, I2 92.2%) was observed between rapid multiplex PCR testing and routine testing.
- No significant difference was observed in overall mortality among patients included in the multiplex PCR test group compared with the routine testing group (RR 0.82, 95% CI 0.57–1.18, I2 25.8%) or at 30-days (RR 0.89, 95% CI 0.70–1.14, I2 6.2%).
This review summarises the clinical impact of rapid, sample-to-answer multiplex PCR systems for respiratory viruses and may prove a useful read to those who would like to implement a change in practice that supports their emergency service provision through the harsh winter months.
The Q-POC™ SARS-CoV-2, Flu A/B and RSV assay is a rapid, sample-to-answer multiplex PCR test designed to be run on the Q-POC™ Platform at the point of care.
With high quality, 6-channel PCR testing, the Q-POC™ SARS-CoV-2, Flu A/B and RSV assay provides simultaneous and accurate diagnosis, triage and management of these clinically similar respiratory infections within 35 minutes. The compact and robust platform is ideal for use in busy clinical setting, and the single use, self-contained cassette ensures safe testing.
Get in touch to find out how the Q-POC™ SARS-CoV-2, Flu A/B and RSV assay could be the testing solution in your clinical practice for the upcoming 2023/24 respiratory season.