Developments offer advantages & challenges
Dramatic innovations in the lab analytics space over recent years are changing the face of clinical care, presenting both benefits and obstacles to providers and patients. Emerging technologies are improving the speed, sensitivity and accuracy of rapid test results. This helps in diagnosing and treating a bevy of infections beyond strep and flu, such as Clostridium difficile, sepsis and encephalitis. But these costly tests need to be understood and used appropriately to achieve the desired results.
“In the molecular field particularly, there’s been so much progress in the last five years that we’re doing things at the point of care we wouldn’t have dreamed of 10 years ago,” says Diane Blankenship, BS, MLT, CLS, ASCP, Senior Director of Laboratory Services at Community Health Systems in Franklin, Tennessee, and a member of HealthTrust’s Laboratory Advisory Board.
“The flu and strep tests are good examples of that,” Blankenship explains. “The advent of molecular testing at the point of care allows providers to have a definitive answer while the patient is present, and that’s a huge advantage. Infectious disease is really making a comeback, which may be the result of overuse of antibiotics—the pathogens we see now are much more resistant to them across the board. It’s important we keep our diagnostic abilities ahead of that, and the molecular piece is key.”
Recognizing strengths & weaknesses
Sometimes dubbed “Lab 2.0,” the development of rapid diagnostics has influenced how microbiology laboratories operate, essentially making the lab a member of the clinical team, says Christa Pardue, MBA, MT(AMT), former Director of Laboratory Services, Clinical Operations for HealthTrust. But choosing the best patients for rapid tests, and understanding the limitations of certain tests, should shape how providers utilize them.
For example, Pardue explains, “If its high expense is not considered, rapid flu testing can become one of the highest wastes of resources in the health system.” She notes that children and the elderly are high-risk groups for whom rapid testing is best used to prevent complications and improve outcomes. “Basic flu screening is the most effective for the majority of the population,” she adds.
At times, the sensitivity of rapid molecular testing becomes a weakness as much as a strength, Pardue says.
This is true for C-diff, where a molecular test can be positive—because of the presence of the bacteria—without an actual infection, spurring overdiagnosis. To counteract this, in 2017 the Centers for Disease Control and Prevention (CDC) recommended an algorithm for C-diff testing that not only detects the bacteria, but also the actual inhibitory activity of the pathogen producing C-diff toxins that indicates an active infection causing serious illness— therefore reducing the risk of overdiagnosis, Pardue explains.
“This is just one example where understanding the technology is essential,” she adds.
In the case of sepsis, microbiology advances have optimized detection days faster than traditional testing could, improving not only survival rates but quality of life, Pardue says. Similarly, encephalitis can be treated much faster. “Rapid testing can precisely identify the offending viral pathogen faster than the spinal fluid cell count, and the differential can be completed,” she says.
Providers are enthusiastic
Providers are generally pleased with the advantages offered by rapid diagnostics and excited for the opportunity to use them, Pardue and Blankenship say. But their enthusiasm may be tempered by budgetary restrictions that limit their choices.
“There are so many different products on the market right now that no one has everything,” Blankenship says. “So it forces labs to make decisions on how to spend their money. Part of the responsibility of the Lab Advisory Board is to be first in line to make sure the products our customers have available to them are what they need and to service all our customers—from large facilities to small critical access hospitals—so they can improve patient care.”
To find out which rapid tests are on contract, refer to the Member Portal for a link to CatScan, or contact your HealthTrust account manager.
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