Not only for
Google:
Why does speed
matter?
Dr. Anne Postulka
Christchurch, NZ, June 2015
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Who am I and where do I come from?
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Who else is there?
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For Google
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Speed matters – also in MedTech
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Content
• Definition of speed
• Objectives of speed
• Feasibility of speed
• Benefits of speed
• What does it take
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Speed? Let’s talk TAT
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Assemble Batch
Set up
Reception
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Run assay
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Assemble Batch
Set up
Run assay
TAT: Is it real?
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17:00
Samples received after 15:00 processed next working day –>
TTR minimum 23h plus transport time
Transcribe
Reception
10:00
Transcribe
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What does
speed mean – for IVDs?
• Speed is TAT, but above all total time-to-result (TTR)
Recommended: the DIY pathway (speed) analysis
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Content
• Definition of speed
• Objectives of speed
• Feasibility of speed
• Benefits of speed
• What does it take
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MEDICAL VALUE
Reducing TTR = Increasing Medical Value
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12 hrs
1 day
Medical Value: Time to Result is crucial
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2 days
TIME TO RESULT
«Better, sooner, more convenient: Increasing youth
friendliness of Family Planning Services in New Zealand »
Ms Rose Stewart, National Nursing Advisor, New Zealand
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Economic and Medical Cost of Delayed Diagnosis
EXPENSE
Potential Economic Impact
• Unnecessary Antibiotics Expense
• Isolation Expenses
• Blocked Bed Expenses
Potential Patient Impact
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•
•
•
Delayed or Wrong Diagnosis
Misuse or Overuse of Antibiotics
Cross-infection
Increased Length of Stay
CEPHEID
PCR
2 HOURS
24 HOURS
48 HOURS
72 HOURS
TIME TO
TEST RESULT
Time to Test Results Costs Money and Lives
Articles that look at time to result as crucial to maximizing diagnostic value:
1. Lance R. Peterson, M.D., Donna M. Hacek, M.T. (A.S.C.P.), Ari Robicsek, M.D., Case Study: An MRSA
Intervention at Evanston Northwestern Healthcare, printed in The Joint Commission Journal on Quality
and Patient Safety Volume 33 Number 12, December 2007
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2. Lance R. Peterson, M.D., Rapid Diagnosis of Community-Acquired MRSA, printed in Clinical
Updates in Infectious Diseases, Volume Issue 3, October 2008
3. Eli N. Perencevich, MD, MS et al., SHEA Guideline: Raising Standards While Watching the Bottom
Line: Making a Business Case for Infection Control, Infection Control and Hospital Epidemiology,
Volume 28, Number 10, October 2007
Meet the Needs of Patients and Physicians
Short TAT, short TTR, actionable results
‒ Improve access to and value of
testing
‒ Avoid disruption of
carer-to-patient-interaction
‒ Personalize care (Chris Price, UK)
‒ Patient-centered, outcomes
focused medicine
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Content
• Definition of speed
• Objectives of speed
• Feasibility of speed
• Benefits of speed
• What does it take
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Reliable, reproducible results anytime, any place
Integrated Platform and Test
Insert Swab into
Elution Reagent Vial
and Break at Score
Vortex and Dispense
Sample into Port S
Insert Cartridge
and Start Assay
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Total Hands-On Time <1 Minute
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Random Access 24/7 – the Alternative
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11:00
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Modules
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• In 8 hours: 50-100 real-time results
• Daily capacity ~250 results with 8 modules used 24/7
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14:00
Feasibility of speed = near-patient
MRSA
Group B Strep
Influenza
CT/NG
C.difficile
Norovirus
Tuberculosis…
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Bringing diagnostics closer to patients
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Content
• Definition of speed
• Objectives of speed
• Feasibility of speed
• Benefits of speed
• What does it take
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Medical and Economic Benefits of Speed
• Speed = short TTR = timely diagnosis
‒ Does it make a difference for patients?
• Where is the evidence?
• And hey: What does it cost?
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Evidence? An example.
Introduction of the first
random access PCR test for
the diagnosis of C.difficile
Infection.
Objective of project:
Answer 2 questions.
1. Do rapid results make a
difference for patients
(outcomes)?
2. How does the impact translate
into costs (or gains) for the
hospital?
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“Cost and Impact on Patient Length of Stay of Rapid
Molecular Testing for Clostridium difficile” 1/2
Study design
‒ Prospective interventional study
‒ 2 acute care hospitals in Swansea, Wales, UK
‒ More than 1,000 consecutive patients enrolled from March to Sept. 2011
Results
Time to reportable result for Xpert C. difficile was on average 1.53h:
‒ 21h faster than reference method for positive samples
‒ 45h faster for negative samples
Length of stay
‒ PCR positive patients were discharged ~4.88 days earlier &
‒ PCR neg. patients ~7.03 days earlier compared to reference method.
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“Cost and Impact on Patient Length of Stay of Rapid
Molecular Testing for Clostridium difficile” 2/2
• Micro-costing results:
‒ Testing cost per sample was £36.18 for PCR, £7.53 for CCNA positive, and
£8.78 for CCNA-negative samples
• With routine use of real-time PCR on all patients in one year
would potentially save 38,247 bed days in ABMUHB.
• Cost of extended LOS has been identified as main cost driver
in CDI.
• Extrapolation: Investing 80 NZD in rapid PCR could provide:
‒ Clinically useful result within 1-2 hours
‒ Reduced LOS
‒ Cost-savings 740 NZD/day; 1,640 NZD per patient
• Conclusion (authors)
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‒ A rapid molecular test for C. difficile in an acute hospital setting produced
quick results that led to a decrease in LOS compared to historic CCNA
control patients. This could result in considerable savings through
© Cepheid reduced excess inpatient days.
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Bode, NL and D
Lonneke G.M.
Bode, M.D.,
Jan A.J.W. Kluytmans, M.D., Ph.D.,
Heiman F.L.
Wertheim, M.D., Ph.D.,
Diana Bogaers, I.C.P.,
Christina M.J.E. Vandenbroucke-Grauls, M.D., Ph.D.,
Robert Roosendaal, Ph.D.,
Annet Troelstra, M.D., Ph.D.,
Adrienne T.A. Box, B.A.Sc.,
Andreas Voss, M.D., Ph.D.,
Ingeborg van der Tweel, Ph.D.,
Alex van Belkum, Ph.D.,
Henri A. Verbrugh, M.D., Ph.D., and
Margreet C. Vos, M.D., Ph.D.
Conclusions
The number of surgical-site
S. aureus infections acquired
in the hospital can be reduced
by rapid screening and
decolonizing of nasal carriers
of S. aureus on admission.
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Bode et al, NEJM: Conclusions
• HAI:
‒ “The results of our trial provide solid evidence of the preventive effect of
S. aureus decolonization and a good estimate of the size of this effect:
the risk of hospital-associated S. aureus infections was reduced by
nearly 60% (3,4% vs. 7,7%))”.
• LOS:
‒ “The mean duration of hospitalization was significantly shorter in the
mupirocin-chlorhexidine group than the placebo group (12.2 vs. 14.0
days)”
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Benefits of Speed: Summary
• The value of rapid results – Is it worth it
‒ Does it make a difference for patients?
‒ Does it cost more (ROI)?
• Fast (and precise) results mean
‒ Optimal patient management and therapy
‒ Avoiding useless and/or harmful interventions
‒ Reducing transmission for infectious diseases and HAIs
‒ Improving Antimicrobial Stewardship
‒ Positively impact overall disease burden with reducing LOS,
related (total) costs, isolation days, expensive cleaning etc.pp
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Content
• Definition of speed
• Objectives of speed
• Feasibility of speed
• Benefits of speed
• What does it take
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What does it take? Change management!
• Put the patient in the center
• Change the patient’s journey
• Plan new pathway and process
• Transform communication
• Manage and lead change
Because it’s the right thing to do.
“Ärmel aufkrempeln, zupacken, aufbauen”
Roll up your sleeves, get a good grip, go!
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Take-home message
Speed matters: For patients and their doctors.
And for Joe, too!
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Thank you.
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