Implementation of the BIOFIRE Meningitis/Encephalitis Panel: A Mixed-Methods Implementation Study in a
Shradha Subedi1,2, N A Patrick Harris1,3, Lisa Hall4
1University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
Background:
Meningitis and encephalitis (ME) are associated with significant morbidity and mortality. Rapid pathogen identification is essential to guide early treatment and support antimicrobial stewardship (AMS). The BIOFIRE® FILMARRAY® ME panel allows simultaneous detection of multiple pathogens from cerebrospinal fluid. This study evaluated the implementation strategy and clinician adoption of the panel in a large nonmetropolitan tertiary hospital in Australia.
Method:
A mixed-methods study was conducted at the Sunshine Coast University Hospital following implementation of the BIOFIRE ME panel. Strategies included education sessions, testing criteria development, and continuous stakeholder engagement. Clinician knowledge, confidence, and antimicrobial decision-making practices were assessed at baseline and during implementation via surveys and semistructured interviews based on the Cabana et al conceptual framework. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed thematically using Braun and Clarke's 5 step process.
Results:
A total of 213 clinicians participated in the surveys across 4 time points. Median perceived usefulness of rapid CSF PCR testing was 9/10. Confidence in ceasing antibiotics based on the assay results increased from 18% at 9 months to 52% at 12 months (P = .06), while confidence in ceasing antivirals remained high (85%-86%). Qualitative findings identified 5 themes influencing implementation: test-ordering practices, perceived diagnostic value, trust in results, antimicrobial stewardship, and behavioral change. Confidence in interpretation was highest where infectious diseases input was available.
Conclusions:
Implementation of the syndromic panel improved diagnostic efficiency and clinician confidence in antimicrobial decision making. Sustained education, multidisciplinary collaboration, and integration of stewardship frameworks were key to achieving successful adoption.
Insights
Implementing a rapid meningitis and encephalitis (ME) panel improved diagnostic efficiency and clinician confidence in antimicrobial decision-making. Multidisciplinary collaboration and education were key to successful adoption of this syndromic testing approach.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Health Services Research
Background:
- Meningitis and encephalitis (ME) pose significant health risks, necessitating rapid pathogen identification for effective treatment and antimicrobial stewardship (AMS).
- The BIOFIRE® FILMARRAY® ME panel offers simultaneous detection of multiple pathogens from cerebrospinal fluid (CSF) samples.
- Evaluating the implementation strategy and clinician adoption of this panel is crucial for optimizing its use in clinical settings.
Purpose of the Study:
- To assess the implementation strategy of the BIOFIRE® FILMARRAY® ME panel in a large nonmetropolitan tertiary hospital.
- To evaluate clinician adoption and its impact on diagnostic efficiency and antimicrobial decision-making.
- To identify factors influencing the successful integration of the ME panel into clinical practice.
Main Methods:
- A mixed-methods study design was employed at Sunshine Coast University Hospital.
- Data collection involved clinician surveys and semistructured interviews assessing knowledge, confidence, and practices.
- Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.
Main Results:
- Clinician confidence in discontinuing antibiotics based on assay results significantly increased post-implementation (18% to 52%).
- Perceived usefulness of rapid CSF PCR testing was high (median 9/10).
- Key themes influencing implementation included ordering practices, diagnostic value, result trust, AMS, and behavioral change, with infectious diseases input enhancing interpretation confidence.
Conclusions:
- The syndromic panel enhanced diagnostic efficiency and clinician confidence in antimicrobial prescribing.
- Sustained education, multidisciplinary collaboration, and integrated stewardship frameworks are vital for successful panel adoption.
- Effective implementation strategies are essential for optimizing the clinical utility of rapid diagnostic panels in managing ME.
