PROJECT DETAILS

Technology has become a part of everyday lives with profound consequences on how we live. However, despite the rapid progression of technology all around us, this has not yet translated into healthcare settings with technology being far behind that of where it should be. Imperial health NHS trust is leading the NHS mission of delivering better care through digital evolution, aiming for technology incorporation that supports clinicians in making more accurate and timely decisions. An example of this includes Point-of-care tests (POCTs).

POCTs have been available within healthcare for decades. However, there has been relatively poor adoption into the clinical practice. Its value in providing clinicians with quick diagnostic information to facilitate their management decisions is increasingly available within hospital departments. The potential utility of POCT for rapid diagnostics of infection, specifically SARS-COV2, has gained urgency during the COVID-19 pandemic.

Pulmonary infection is a common cause of admission to intensive care units (ITU), with up to 10% of patients admitted with pneumonia requiring critical care. In current practice, antibiotics for suspected pulmonary infections are initiated empirically (i.e., pending microbiological evidence of infection) and continued even if no pathogens have been seen or cultured. This reflects a cautious approach to antibiotic prescribing, which is often attributed to illness severity and/or diagnostic uncertainty. It can result in unnecessarily prolonged antibiotic courses, particularly in the critically ill. Point-of-care tests (POCTs) could help to resolve clinical uncertainty, thereby reducing the antibiotic burden (both physical and economic) upon individual patients and wider health systems.

However, a number of studies demonstrate infection-identifying POCT has not yet demonstrated an ability to influence decision-making for antibiotic stewardship. Thus, the unexpected inability of certain biomarker-related POCT results to influence antibiotic–stop decision making, despite the validity of the test results. The behavioural influences in decision making about antibiotic cessation, are identified as crucial in the utility of such devices. However, little research exists into the reasons behind prescribing behaviour, and ultimately whether such POCT devices may or not benefit clinical decision-making in this regard. 

We seek to explore these influencing factors.