|Year : 2020 | Volume
| Issue : 2 | Page : 82-84
The impact of different methods of COVID-19 sample analysis upon patient stay duration between arrival at the emergency department and hospital admission
Talhah Mohammed1, Mitul Patel2
1 King's College London, Medical School, Guys Campus, London, UK
2 Birmingham Children's Hospital, Birmingham, UK
|Date of Submission||13-Jan-2021|
|Date of Acceptance||13-Jan-2021|
|Date of Web Publication||5-Apr-2021|
Dr. Talhah Mohammed
36 Lysways Street, Walsall, WS1 3AQ
Source of Support: None, Conflict of Interest: None
BACKGROUND: Sars-Cov2 is a respiratory disease causing virus that originated in Wuhan, China with the officials in the country first reporting it in December 2019. It results in the condition Covid-19, with the main symptoms associated with the virus being a high temperature, a continuous cough and a loss or change of taste and smell.
AIMS AND OBJECTIVES: An assessment of service provision was conducted to see how the involvement of different analysers with its different systems, impacted upon the duration that patients spent on Paediatric Assessment Unit (PAU); an intermediary unit linking the Emergency Department to further hospital wards. The preferred screening for the virus by Public Health England (PHE) involves molecular diagnosis by real-time PCR.
MATERIALS AND METHODS: Fifty samples were collected between March and July, and the patient duration spent on PAU was seen to decrease as the months progressed. To the best of our knowledge, this is a novel study which has not yet taken place before.
RESULTS: As the months progressed, the average time patients spent on PAU from March to July was shown to have reduced.
CONCLUSION: The decrease in duration mirrored the change in service provision; namely the implementation of a random-access analyser, allowing for enhanced patient movement within the hospital.
Keywords: Emergency department, SARS-CoV2, turnaround times
|How to cite this article:|
Mohammed T, Patel M. The impact of different methods of COVID-19 sample analysis upon patient stay duration between arrival at the emergency department and hospital admission. J Acad Clin Microbiol 2020;22:82-4
|How to cite this URL:|
Mohammed T, Patel M. The impact of different methods of COVID-19 sample analysis upon patient stay duration between arrival at the emergency department and hospital admission. J Acad Clin Microbiol [serial online] 2020 [cited 2021 Apr 23];22:82-4. Available from: https://www.jacmjournal.org/text.asp?2020/22/2/82/313075
| Introduction|| |
Covid-19 emerged in December 2019, and since then the United Kingdom has been hit particularly badly by the virus. As of today, the 14th October 2020, the country currently ranks 7th in terms of global infections, with over 500,000 positive cases being reported. Consequently, the UK healthcare service has been particularly stretched during this period.
The National Health Service is a publicly funded healthcare system in England – free at the point of delivery. As opposed to the US and other countries, UK citizens need not pay for health insurance as the cost of all treatment is funded by the government through taxation and various other means. Amidst the pandemic, guidelines from the Department of Health stipulated that all emergency admissions are to be screened for SARS-CoV2 upon hospital admission. At the Birmingham Children's Hospital (BCH), all emergency admissions via the emergency department (ED) are further transferred to paediatric assessment unit (PAU) (adjacent to ED), until their COVID result becomes available. Patients are then admitted to the respective wards depending on their result.
Although guidelines from the Department of Health state that it is no longer mandatory to abide by the four-hour ED turnaround time for patients, stress is still placed on the swift discharging and admitting of patients. As BCH is a trauma centre and the sole tertiary paediatric centre of care in the West Midlands, there was a danger of saturated bed occupancy in light of COVID-19, potentially resulting in delayed patient treatment. This could have led to worsening ED performance times if all beds in the PAU were occupied, as it would mean that the transfer of patients from ED to PAU would stagnate. As a result, increased emphasis was placed on the turnover times of SARS-CoV2 results to allow further admissions into the hospital. Despite the emphasis, no specific target turnaround times were agreed upon between the laboratory and the wards, and so, the main goal was to release results as soon as possible.
Due to the limited availability of tests, discretion is advised in the selection of analyser to not only ensure smooth hospital movement but also prevent a backlog in further COVID testing; an incident that occurred only recently within satellite laboratories across the country.
For the detection of SARS-CoV2 RNA, molecular techniques were employed in the Microbiology laboratory at BCH.
| Materials|| |
Data were retrospectively collected from laboratory information management systems. From March to July, an average of 232 samples from emergency department (ED) and PAU were tested for COVID-19. For the purpose of this study, 10 cases were arbitrarily selected by simple random sampling, with the criteria that they had spent some time on PAU and were thereafter transferred onto another ward as opposed to being discharged.
The data included the dates and times when patients admitted into the hospital and the dates and times when they were moved onto another ward following the authorisation of their COVID-19 result. As no confidential information was recorded, patient consent was not required.
| Results|| |
The average time spent by patients on PAU was shown to have reduced as the months progressed from 51.1 h in March and 31.8 h in April, to 19.8 h in May, 17 h in June and 14.8 h in July [Figure 1]. In March and the first half of April, all SARS-CoV2 samples were sent to a neighbouring hospital for processing due to the unavailability of a functioning analyser at BCH. 14th April saw samples first being processed in-house, assisted by 3 Elite InGenius analysers (ELITechgroup, Puteaux, France). From 5th June onwards, the Panther (Hologic, Massachusetts, US) analysers were thereafter used. July saw the first batch of SARS-CoV2 samples being processed overnight, whereas before this, COVID was only routinely processed from 8 AM to 8 PM.
| Discussion|| |
From the data gathered, the most effective form of analyser in terms of quicker turnaround times, and hence faster patient movement, is Hologic's Panther. Interestingly, this is despite the fact that the Panther analyser actually takes longer time to analyse a single SARS-CoV2 sample, with a run taking approximately 3.5 h compared to the three-hour duration of the Elite InGenius. However, the random-access design of the Panther analyser allows for a feed-through mechanism meaning that samples can be processed without having to wait for current batches of runs to finish [Table 1].
This differs from the Elite InGenius, where samples can only be processed in batches which are collected over time, introducing delays in the whole process.
As a result, the reason as to why average patient duration on PAU drastically improved can be initially put down to SARS-CoV2 samples being processed in-house and thereafter due to the analyser in use being more efficient in generating results. The additional run being processed overnight also impacted positively, shown by the time difference in June compared to July.
| Conclusion|| |
Our audit seems to suggest that there is an association between COVID test service provision and duration of admission in the PAU; however, it should be noted that it is not the only association which impacts upon the duration. This study shows that for the rapid availability of SARS-CoV2 results, a random-access analyser is more efficient, allowing for enhanced patient movement within the hospital. This would incur further benefits, such as ED being able to admit more patients while improving the turnaround times to meet the expected four-hour target.
Looking to the future, point-of-care testing with a 20-min duration is currently being explored, both of which reduce the turnaround times even further, diminishing both the wait and the burden placed upon laboratories nation-wide.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 94. Geneva: World Health Organization; 2020.
Aptima® SARS-CoV-2 Product Literature Assay (Panther System). Geneva: Hologic; 2020. p. 3.
Brendish NJ, Poole S, Naidu VV, Mansbridge CT, Norton NJ, Wheeler H, et al
. Clinical impact of molecular point-of-care testing for suspected COVID-19 in hospital (COV-19POC): A prospective, interventional, non-randomised, controlled study. Lancet Respir Med 2020;8:1192-1200.