Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.
Influenza Other Respir Viruses. 2021 Mar;15(2):254-261. doi: 10.1111/irv.12800. Epub 2020 Aug 26.
Seasonal influenza causes significant morbidity and mortality and incurs large economic costs. Influenza like illness is a common presenting concern to Emergency Departments (ED), and optimizing the diagnosis of influenza in the ED has the potential to positively affect patient management and outcomes. Therapeutic guidelines have been established to identify which patients most likely will benefit from anti-viral therapy.
We assessed the impact of rapid influenza PCR testing of ED patients on laboratory result generation and patient management across two influenza seasons.
A pre-post study was performed following a multifaceted clinical redesign including the implementation of rapid influenza PCR at three diverse EDs comparing the 2016-2017 and 2017-2018 influenza seasons. Testing parameters including turn-around-time and diagnostic efficiency were measured along with rates of bed transfers, hospital-acquired (HA) influenza, and ED length of stay (LOS).
More testing of discharged patients was performed in the post-intervention period, but influenza rates were the same. Identification of influenza-positive patients was significantly faster, and there was faster and more appropriate prescription of anti-influenza medication. There were no differences in bed transfer rates or HA influenza, but ED LOS was reduced by 74 minutes following clinical redesign.
Multifaceted clinical redesign to optimize ED workflow incorporating rapid influenza PCR testing can be successfully deployed across different ED environments. Adoption of rapid influenza PCR can streamline testing and improve antiviral stewardship and ED workflow including reducing LOS. Further study is needed to determine if other outcomes including bed transfers and rates of HA influenza can be affected by improved testing practices.
季节性流感可导致严重的发病率和死亡率，并造成巨大的经济成本。流感样疾病是急诊科常见的就诊原因，优化急诊科流感诊断可能对患者管理和结果产生积极影响。已制定治疗指南以确定最有可能从抗病毒治疗中获益的患者。
我们评估了在两个流感季节中，对急诊科患者进行快速流感 PCR 检测对实验室结果生成和患者管理的影响。
在包括在三个不同急诊科实施快速流感 PCR 的综合临床重新设计之后，进行了一项前后研究，比较了 2016-2017 年和 2017-2018 年流感季节。测量了检测参数，包括周转时间和诊断效率，以及床位转移率、医院获得性（HA）流感和急诊科住院时间（LOS）。
在干预后期间，对出院患者进行了更多的检测，但流感发生率相同。流感阳性患者的识别速度明显加快，抗流感药物的使用更快且更合理。床位转移率或 HA 流感无差异，但临床重新设计后急诊科 LOS 减少了 74 分钟。
优化急诊科工作流程并纳入快速流感 PCR 检测的综合临床重新设计可以在不同的急诊科环境中成功部署。采用快速流感 PCR 可以简化检测，并改善抗病毒管理和急诊科工作流程，包括缩短 LOS。需要进一步研究以确定其他结果（包括床位转移率和 HA 流感发生率）是否可以通过改进的检测实践来影响。
