Near patient testing to enhance the microbiological diagnosis of infectious meningitis in the context of a networked pathology service

Abstract

(a) A description of the planned innovation and how will this improve the quality of health and care? This innovation project proposal will develop a case for the deployment of near-patient highly multiplexed molecular testing for infections of the central nervous system. North West London Pathology provides diagnostic laboratory services for a network of three hospital trusts consisting of seven hospitals. Laboratory services are centralised on a single hub site but with some point of care and biochemistry testing retained at each hospital (spoke sites) Diagnostic services for the detection of infectious meningitis are currently performed in the hub laboratory and are also split across the bacteriology and virology disciplines. This means there is a requirement to transport samples to the hub laboratory and to move samples between departments, with resultant delays to test turnaround time. It is proposed to explore the possibility of deploying test platforms of reduced complexity in the small laboratories within the spoke sites, thus overcoming delays resulting from transport and multiple testing. Harmonising bacteriological and virological testing to a single test deployed within the spoke hospitals will improve the quality of patient care as this will reduce the time taken to achieve a microbiological result in a case of query CNS infection. This will have concomitant benefits upon antimicrobial stewardship and the length of inpatient stays, at both the per patient and hospital level.

(b) an outline of your intended method(s) and approach A literature review will be undertaken in order to gather evidence for the deployment of CNS diagnostics in near-patient settings and used to guide business case development. The literature will encompass the following areas; burden of CNS infections in the UK, current diagnostic/clinical guidelines for their management, the role of point of care (PoC) testing in the networked laboratory, the performance (laboratory/clinical) of existing PoC tests for CNS infection. Following this a business case will be developed, regarding the potential deployment options for the deployment of near patient testing in the spoke laboratories. Data will be extracted from the laboratory information management system regarding the number of cerebral spinal fluid (CSF) samples submitted for bacterial/viral PCR. This will provide an indicative yearly workload, stratified by hospital site. The business case will also seek describe the direct (consumables, staff) and indirect (Anti-infective usage, bed days) economic costing that would be anticipated following deployment. Finally, user engagement activities will be undertaken to ascertain the potential utility of the innovation to both hospital microbiologists and emergency department staff. This engagement activity will be used to determine if users may be able to identify additional value or pitfalls of deploying a near patient approach to the microbiological diagnosis of infectious meningitis.

Outputs

I have been unable to complete my project as I have been seconded to work on the national COVID response, working first within the ‘Virology Cell’, then recently taking a secondment to the DHSC to work on test triage. I have contributed to government documents and hope I may be able to apply this work to my innovation project. https://www.gov.uk/government/publications/covid-19-phe-laboratory-assessments-of-molecular-tests