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FilmArray: Vancouver General Hospital is decreasing patient isolation by 4 days

BioFire FilmArray® Respiratory Panels decreased isolation times by four days, according to study conducted at Vancouver General Hospital.

From December 2016 to May 2017, researchers at Vancouver General Hospital conducted a randomized control trial to evaluate the clinical impact, infection control impact and cost effectiveness of the BioFire FilmArray Respiratory Panel assay in 158 patients with respiratory infections.

More specifically, researchers were keen to see what effect this new technology would have on the amount of time that patients are kept in infection control isolation.

The results of the study were encouraging in this regard: Implementing the BioFire FilmArray Respiratory Panel decreased isolation times by approximately four days compared to routine testing.

“When a patient comes into the emergency room with any type of worsening respiratory illness, or if they come in with an abnormal chest x-ray, we put them in isolation right away because we don’t yet know what they have,” says Dr. Titus Wong, primary investigator of the study and Medical Microbiologist and Infection Control Physician at Vancouver General Hospital. “The sooner we can rule things out, the better for patient care, as well as for bed management and bed flow.”

The BioFire FilmArray Respiratory Panel is capable of detecting 17 viral and three bacterial targets in one hour—an accelerated diagnostic turnaround that Dr. Wong sees as a game changer.

“Once that swab gets into our hands, we can have a result ready for physicians in an hour, which is something that we’ve previously never been able to do. At best, we could give them a result for in-house work anywhere from a few hours up to a day. And if we had to send anything out to the reference centre, it could take anywhere from 24 hours to five days.”

“Having the certainty of being able to promise a result in an hour,” he continues, “is extremely powerful.”

The Microbiology Laboratory team and the Infection Control team collaborated hand in hand on this study, which Dr. Wong also says was key. “We have a very close working relationship between Medical Microbiology and Infection Control, as well as with our colleagues in Quality Patient Safety and Infectious Disease. These relationships allow us to advocate for each other in various areas and help articulate the needs of each group.”

Cost-effectiveness is, of course, of paramount concern in any hospital setting. “In a health care environment where there are always limited resources and competing interests, it’s really refreshing to work in an area—this whole infection area—where everyone can focus on mutually prioritized goals that can benefit us all,” says Dr. Wong.

Having diagnostic certainty a lot sooner in the patient journey is one such goal. “For the patient, this helps improve response times not only for treatment, but also for infection control. And for the hospital, it helps improve bed management and bed flow time. All of these things combined ultimately improve patient outcomes and satisfaction, and also help save hospital resources and divert them to other areas where they’re needed.”

With a quicker diagnostic response time, patients with negative results aren’t kept on isolation longer than necessary. “We want to keep patients in isolation to make sure that other patients and health care workers are protected from potential pathogens,” says Dr. Wong. “But only as long as it’s necessary. The fact that we’re only keeping a patient in isolation for hours as opposed to days is very impactful for patient care—and for the hospital.”

With a limited number of isolation rooms in the hospital, freeing up a bed for another patient who needs it is key.

Quicker response times also have a clinical impact on the most vulnerable patients in the hospital. “Everybody—especially our critical care physicians and transplant physicians—was extremely grateful for the turnaround time and the comprehensiveness of the panel,” says Dr. Wong. “There’s typically a plethora of potential etiologies, and being able to quickly rule something in or out helps us on that diagnostic pathway. It helps us direct hospital resources and human resources towards another diagnosis during these critical hours of care.”

According to Dr. Wong, many of the physicians wrote supporting letters advocating for the technology and its impact on patient care. “As the study went on, we’d get requests from certain critical care colleagues asking, ‘Could my patient get, quote unquote, randomized to the treatment on the test arm?’ And we’d say, ‘Sorry, it doesn’t work that way!’ But it speaks to how much they like the technology.”

With minimal hands-on time required, the BioFire FilmArray Respiratory Panel takes only a few minutes to run a sample, which Dr. Wong also sees as an effective use of resources. “It frees up the technologist to work on other tasks that require their expertise.”

What’s next for Dr. Wong and his team? “Well, first of all, we have a responsibility to share our experience, so we’re presenting at multiple conferences. We’re also working on a manuscript and that should be coming out very shortly.”

Dr. Wong can’t say enough about the teams within the hospital that advocated for the implementation of the BioFire FilmArray Respiratory Panel:

“When you’re in different areas of expertise, you might not be aware of the newest or latest or most advanced technologies available. And so you really need the people in the know—the diagnostic microbiology and infectious disease physicians and infectious control physicians—to speak up and advocate for them.”

“We’d also like to thank Quality Patient Safety and our administrators for really jumping on board and supporting this. They think that it’s good value for patient care and for the hospital.”

The use of the BioFire FilmArray Respiratory Panels won’t, however, be limited to Vancouver General Hospital. “We’re also a regional laboratory for multiple health care institutions, and we have a plan to roll out testing to these other institutions as well,” confirms Dr. Wong.

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