Hull York Medical School University of Hull University of York University of Liverpool Hull University Teaching Hospital NHS Trust King's College Hospital NHS Foundation Trust

BioDrive Antifungal Stewardship:

Improving Turnaround Time

Three main processes should be considered with the TAT for any test.

Contents

Click on the each of the 4 areas below to jump to the relevant sections.

Short-term change

Initially consider targeting ‘low-hanging fruit’ – those processes that can be changed quickly at no or minimal cost. The flowchart below shows what we have learned qualitatively about TAT in setting-up the BioDriveAFS trial so far. Have a look at the figure below and reflect on your local processes and performance.

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In the following video, Dr Thomas Taynton, Clinical Research Fellow and MD student discusses what has been learnt about TAT with the BioDriveAFS trial in Hull York Medical School so far.

In the following video, Dr Laura Sheard, Associate Professor of Health Sciences at the University of York, and Dr Sarah Baz, Qualitative Research Fellow at the University of York, discuss what they have learned about TAT with the BioDriveAFS trial.

Longer-term change

Some processes may take longer or are more challenging to change because of costs, logistics or other reasons.

One example from the trial so far is that some centres currently send their samples by second-class post to the biomarker testing laboratory. At first, this may seem like a ‘low-hanging fruit’ and quick to change, for example, to a courier service. However, any such change tends to take time within the NHS because of the cost, logistical and organisational implications. Having said that, a quick interim change could be to first-class post, which would be relatively low cost.

Although it is beyond the scope of this educational package, it is worth mentioning at this point that the interpretation of any IFI biomarker test, and the subsequent clinical decisions thereafter, is complex and requires a multi-disciplinary approach. See Lessons from an Educational Invasive Fungal Disease Conference on Hospital Antifungal Stewardship Practices across the UK and Ireland, available here.

Click below to explore our case studies

In the following video, Dr Lewis White, Consultant Clinical Science and Head of Mycology Wales Reference Unit, describes an array of factors influencing the TAT for results.

In the following video, Dr Nelun Perera, Consultant Microbiologist at the University Hospitals of Leicester, describes her experience of using the Galactomannan lateral flow test to ‘2nd-check’ the result of the Platelia test. Note that NPEX is now referred to as Labgnostic. 

In the following video, Dr Richard Barton, Principal Clinical Scientist at the Leeds Teaching Hospitals Trust, describes his experience of improving TATs for acute mycology tests. Note that NPEX is now referred to as Labgnostic. 

In the following video, Dr Alex Howard, Consultant Microbiologist at Liverpool University Hospitals, discusses what has been learnt so far about fungal biomarker TATs. Note that NPEX is now referred to as Labgnostic. 

Auditing

Consider auditing your current TAT using the principals above and the provided audit tool (available to download here) to guide you. Feel free to adapt the audit tool to your local circumstances. After all, “To measure is to know.”

By using this audit tool regularly (for example, every 3 to 6 months) in a randomly selected sub-set of patients undergoing biomarker testing (for example n = 20) you will be able to quickly assess whether changes have reduced TAT over time.

Additional resources

If you require more information about quality improvement and measurement, Week 3 of the British Society of Antimicrobial Chemotherapy (BSAC) and University of Dundee’s FutureLearn course Antimicrobial Stewardship: Managing Antibiotic Resistance has some useful learning within it. While this is targeted at antibiotic use, the principals are similar.

This e-learning course is available here. Other useful BSAC courses are available here, here, and here

Furthermore, Chapter 27 of the free-to-access BSAC e-book ‘Antimicrobial Stewardship: from principles to practice’ covers AMS and diagnostics. Other chapters, for example, quality improvement and measurement, may also be useful in addressing TAT.

You can access this e-book here.

References

  1. Talento, A.F., et al. (2021). Lessons from an educational invasive fungal disease conference on hospital antifungal stewardship practices across the UK and Ireland. Journal of Fungi7(10), p.801. Here: https://doi.org/10.3390%2Fjof7100801