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Impact of a rapid respiratory panel test on patient outcomes
Beverly B Rogers1, Prabhu Shankar, Robert C Jerris
1From the Departments of Pathology (Drs Rogers and Jerris and Ms Uwindatwa), Pediatrics (Drs Kotzbauer and Anderson), Infection Control (Ms Watson), and Statistics (Drs O'Brien and Bost and Ms McNamara), Children's Healthcare of Atlanta; and Departments of Pathology (Drs Rogers and Jerris), Medicine (Dr Shankar), and Pediatrics (Dr Anderson), Emory University School of Medicine, Atlanta, Georgia.
Insights
The rapid respiratory panel (RRP) test significantly reduced antibiotic duration, hospital stay, and isolation time for children with respiratory illnesses. This advanced testing improves patient outcomes and healthcare efficiency.
Area of Science:
- Infectious Disease Diagnostics
- Pediatric Hospital Medicine
- Health Services Research
Background:
- Polymerase chain reaction (PCR) testing for infectious pathogens has evolved with a focus on value-based medicine.
- Rapid diagnostic tests aim to improve patient care and resource utilization.
Purpose of the Study:
- To evaluate the impact of implementing the FilmArray rapid respiratory panel (RRP) on clinical outcomes for hospitalized children with acute respiratory tract illness.
- To assess if RRP's faster results and expanded panel influence treatment duration and length of stay.
Main Methods:
- A comparative study analyzing patient outcomes before (November 2011-January 2012) and after (November 2012-January 2013) RRP implementation.
- Included inpatients aged 3 months+ with acute respiratory tract illness.
- Compared traditional batched PCR testing with the comprehensive RRP.
Main Results:
- RRP implementation significantly reduced mean time to result (383 vs. 1119 minutes) and increased emergency department result availability (51.6% vs. 13.4%).
- Shorter antibiotic duration was observed post-RRP, particularly when results were available within 4 hours.
- Positive RRP results correlated with decreased inpatient length of stay and time in isolation.
Conclusions:
- The RRP test effectively decreases antibiotic use duration, length of inpatient stay, and patient isolation time.
- RRP implementation contributes to more efficient care for pediatric respiratory infections.
Context:
Evolution of polymerase chain reaction testing for infectious pathogens has occurred concurrent with a focus on value-based medicine.
Objective:
To determine if implementation of the FilmArray rapid respiratory panel (BioFire Diagnostics, Salt Lake City, Utah) (hereafter RRP), with a shorter time to the test result and expanded panel, results in different outcomes for children admitted to the hospital with an acute respiratory tract illness.
Design:
Patient outcomes were compared before implementation of the RRP (November 1, 2011, to January 31, 2012) versus after implementation of the RRP (November 1, 2012, to January 31, 2013). The study included inpatients 3 months or older with an acute respiratory tract illness, most admitted through the emergency department. Testing before RRP implementation used batched polymerase chain reaction analysis for respiratory syncytial virus and influenza A and B, with additional testing for parainfluenza 1 through 3 in approximately 11% of patients and for human metapneumovirus in less than 1% of patients. The RRP tested for respiratory syncytial virus, influenza A and B, parainfluenza 1 through 4, human metapneumovirus, adenovirus, rhinovirus/enterovirus, and coronavirus NL62.
Results:
The pre-RRP group had 365 patients, and the post-RRP group had 771 patients. After RRP implementation, the mean time to the test result was shorter (383 minutes versus 1119 minutes, P < .001), and the percentage of patients with a result in the emergency department was greater (51.6% versus 13.4%, P < .001). There was no difference in whether antibiotics were prescribed, but the duration of antibiotic use was shorter after RRP implementation (P = .003) and was dependent on receiving test results within 4 hours. If the test result was positive, the inpatient length of stay (P = .03) and the time in isolation (P = .03) were decreased after RRP implementation compared with before RRP implementation.
Conclusions:
The RRP decreases the duration of antibiotic use, the length of inpatient stay, and the time in isolation.
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