Mapping decision-making pathways: Determination of intervention entry points for diagnostic tests in suspected serious infection

Naseem, Raasti ORCID: 0000-0003-1978-4370, Howe, Nicola ORCID: 0000-0001-9446-8314, Pretorius, Sara ORCID: 0000-0001-8277-711X, Williams, Cameron, Lendrem, Clare, Pallmann, Philip ORCID: 0000-0001-8274-9696 and Carrol, Enitan D ORCID: 0000-0001-8357-7726 (2024) Mapping decision-making pathways: Determination of intervention entry points for diagnostic tests in suspected serious infection NIHR Open Research, 4. p. 35. ISSN 2633-4402, 2633-4402

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Abstract

<ns3:p>Background PROTECT (Platform Randomised evaluation of clinical Outcomes using novel TEChnologies to optimise antimicrobial Therapy) has brought together a team of researchers to design a platform trial to rapidly evaluate and adopt into care multiple diagnostic technologies, bringing immediate benefit to patients. Rapid diagnostic tests will be used to identify patients at risk of deterioration from severe infection, before they become critically unwell. The platform will assess their comparative clinical and cost-effectiveness relative to current standard of care. Preliminary work, conducted under a Health Technology Assessment Application Acceleration Award, provided key evidence to optimise the design of the PROTECT platform. Methods Qualitative methods which involved consulting key stakeholders in the field of serious infection addressed the key priorities. A high-level care pathway analysis focusing on serious infection in secondary care, captured the points of contact, actions, decisions, and potential outcomes associated with a patient’s care. Results Two use cases of rapid diagnostic tests for serious infection were identified; (1) in acute emergency medicine to decide on antimicrobial initiation and/or escalation of care, and (2) in hospitalised patients to monitor treatment response. Within the emergency department, clinicians believed a test would be used as an adjunct to existing standard of care and would be used to either rule-in or rule-out serious infection. The “ideal” test should be rapid, point-of-care, cheap to procure, have capacity for high usability, and ability to be performed and interpreted by all staff. Facilitators to the adoption of infection diagnostic tests is their clinical need, and the main potential barrier is poor change management and behavioural change. Conclusions Any new test should provide robust evidence of its effectiveness and have the potential to benefit the clinical pathway for patients, clinicians, and hospitals as a whole, to be considered for adoption as a new standard of care.</ns3:p>

Item Type:	Article
Uncontrolled Keywords:	4203 Health Services and Systems, 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 42 Health Sciences, Cost Effectiveness Research, Comparative Effectiveness Research, Health Services, Clinical Research, Emergency Care, Bioengineering, 4.2 Evaluation of markers and technologies, 7.3 Management and decision making, 4.1 Discovery and preclinical testing of markers and technologies, Infection, 3 Good Health and Well Being
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	15 Jan 2025 11:33
Last Modified:	30 Jan 2026 23:41
DOI:	10.3310/nihropenres.13568.1
Related Websites:	Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3189710
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