April 2020, research staff from NIHR Cambridge Clinical Research Facility were deployed onto the wards at Cambridge University Hospitals (CUH) to start using a new test for a research trial to diagnose COVID-19.
The research trial was called COVIDx, investigating a new test for COVID-19 on delivering faster diagnoses and understanding the development of immunity following infection and evaluating the accuracy of the new SAMBA II-based test and whether it speeds up the diagnosis of COVID-19 in a ‘real-time’ hospital setting at the point of care (POC).
The study results have been published here in Cell Reports Medicine have revealed, as you can imagine, patient placement during the COVID-19 pandemic had been a significant challenge and has had a great impact on the ability to maintain patient flow and safety in the hospital.
The trial data on SAMBA II was able to address these problems.
Our hospital switched from standard lab RT-PCR testing to SAMBA II for in-hospital testing immediately following the end of the validation study, providing an opportunity to evaluate almost 1,000 tests performed over 10 consecutive days.
Most of the tests were performed on new admissions to the hospital and replicated the significant reduction in test turnaround time observed in the clinical validation trial. The testing was also used to investigate newly symptomatic patients in hospital to rationalise our limited isolation rooms, and also to rapidly identify new COVID-19 cases, with appropriate infection control and prevention of hospital acquired transmission.
Patients who are ‘inappropriately isolated’ is a large drain on staff and resources due to the need for repeated deep cleaning, additional personal protective equipment (PPE) utilisation and the distress and risk to patients from repeated bed moves.
Using this testing method, it was observed that a significant increase in the availability of isolation or single-occupancy rooms following POC introduction, and patients who tested negative were able to be placed in low-risk areas of the hospital and have interventions and procedures could happen without further delay.
The study found that 11 ward closures were prevented in the 10-day post-implementation phase by there being negative tests in symptomatic hospital patients. Closed surgical bays in particular can result in the cancellation of operations, as well as significant financial losses to hospitals. Following this analysis, hospital guidelines will be adapted to recommend waiting for SAMBA test results before moving patients into isolation or closing bays.
When we performed a formal implementation impact analysis using 10-day windows on either side of May 2, 2020, we found that time to definitive ward move from admission decreased significantly after the introduction of SAMBA II SARS-CoV-2 testing, and length of stay on the main holding ward where test results were awaited also fell significantly, which is consistent with more rapid and accurate patient movement.
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