Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: A retrospective observational study across six Australian hospitals

Wabe, N; Li, L; Dahm, MR; Lindeman, R; Yimsung, R; Clezy, K; Thomas, J; Varndell, W; Westbrook, J; Georgiou, A

Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: A retrospective observational study across six Australian hospitals

Wabe, N Li, L Dahm, MR Lindeman, R Yimsung, R Clezy, K Thomas, J Varndell, W

Westbrook, J Georgiou, A

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Publication Type:: Journal Article
Citation:: BMJ Open, 2019, 9 (8)
Issue Date:: 2019-08-01

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Field	Value	Language
dc.contributor.author	Wabe, N	en_US
dc.contributor.author	Li, L	en_US
dc.contributor.author	Dahm, MR	en_US
dc.contributor.author	Lindeman, R	en_US
dc.contributor.author	Yimsung, R	en_US
dc.contributor.author	Clezy, K	en_US
dc.contributor.author	Thomas, J	en_US
dc.contributor.author	Varndell, W https://orcid.org/0000-0002-4752-9679	en_US
dc.contributor.author	Westbrook, J	en_US
dc.contributor.author	Georgiou, A	en_US
dc.date.accessioned	2020-04-16T07:25:21Z
dc.date.available	2020-04-16T07:25:21Z
dc.date.issued	2019-08-01	en_US
dc.identifier.citation	BMJ Open, 2019, 9 (8)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/140045
dc.description.abstract	© 2019 Author(s). Objective: A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes. Design: Retrospective observational study. Setting: Linked ED and laboratory data from six EDs in New South Wales, Australia. Participants: Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient's ED arrival to time of sample receipt at the hospital laboratory. Outcome measures: ED length of stay (LOS), >4 hour ED LOS and having a pending RMDT result at ED disposition. Results: A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133-349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8-26.1; p<0.001), a 51% increase in the likelihood of staying >4 hours in ED (OR, 1.51; 95% CI, 1.41 to 1.63; p<0.001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04; 95% CI, 1.02 to 1.05; p<0.001) after adjustment for confounders. Conclusion: The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.	en_US
dc.relation.ispartof	BMJ Open	en_US
dc.relation.isbasedon	10.1136/bmjopen-2019-030104	en_US
dc.title	Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: A retrospective observational study across six Australian hospitals	en_US
dc.type	Journal Article
utslib.citation.volume	8	en_US
utslib.citation.volume	9	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1199 Other Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access
pubs.issue	8	en_US
pubs.publication-status	Published	en_US
pubs.volume	9	en_US

Abstract:

© 2019 Author(s). Objective: A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes. Design: Retrospective observational study. Setting: Linked ED and laboratory data from six EDs in New South Wales, Australia. Participants: Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient's ED arrival to time of sample receipt at the hospital laboratory. Outcome measures: ED length of stay (LOS), >4 hour ED LOS and having a pending RMDT result at ED disposition. Results: A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133-349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8-26.1; p<0.001), a 51% increase in the likelihood of staying >4 hours in ED (OR, 1.51; 95% CI, 1.41 to 1.63; p<0.001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04; 95% CI, 1.02 to 1.05; p<0.001) after adjustment for confounders. Conclusion: The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.

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http://hdl.handle.net/10453/140045