How our pathology service developed a rapid-result flu test service

Almost 90 per cent of flu tests run across our hospitals see results within six hours thanks to improvements implemented by North West London Pathology. The rapid-result flu test team, pictured at left, won the Chair’s award at the Trust’s 2019 Make a Difference awards for their improvements. Paul Randell, consultant virologist and part of the team who developed the service, explains how they did it.

Winter can be a challenging time for hospitals. Alongside potential extreme weather, annual influenza (or flu) season tends to run between December to March. This places a significant burden on the NHS: in addition to the resources needed to treat flu patients, there are substantial costs related to infection control and bed management.

Diagnosing flu early is vital. This is not least because it enables appropriate treatment to be started more quickly – it’s also pivotal to effective bed management. Patients with flu should be isolated from other patients to control the spread of the virus, and the longer a patient is on the ward with undiagnosed flu the higher the risk of it spreading to other patients. Vulnerable individuals, for example those with cancer, can become seriously unwell if they catch flu.

After close evaluation of data, at the end of 2018 I was part of the team at North West London Pathology (NWLP) that began to develop a screening service for flu that is more rapid, responsive and flexible than what was currently on offer.

Identifying what could be improved

Historically, NWLP has increased its respiratory testing service from five days a week to seven during flu season. This improved capacity, but it had its limitations.

While we do have labs on our different hospital sites across north west London, our flu samples were all tested at Charing Cross Hospital. Samples from patients in the other hospitals would be couriered to Charing Cross. Logistically this was quite challenging, and meant all samples needed to be received by the lab before 12.30 for a result to be available that day.

Data showed that less than a quarter (24 per cent) of respiratory samples had a result available within 24 hours of collection.

Introducing analysers across the labs

We knew we had to improve turnaround time – key to doing this was to decentralise the service and to offer a new rapid flu test.

We worked with colleagues across different sites from virology, microbiology, blood sciences and pathology IT/Trust IT to introduce rapid flu testing in laboratories beyond Charing Cross, to our Hammersmith and St Mary’s hospitals.

The combination of moving the testing nearer the patient with using a rapid test, which can provide a result within two hours of receipt in the lab, leads to much faster results to assist staff in appropriately treating patients. This rapid flu test has been rolled out across the Trust alongside the existing routine multiplex respiratory virus screen that was used pre-2018.

What this means for our patients

We rolled out this service in time for last year’s flu season – and the initial data shows a marked improvement on turnaround time.

Almost nine in 10 (88 per cent) rapid flu results were reported on the system within six hours of collection, compared to 24 per cent of results available within 24 hours during the last flu season.

How we’ll continue to improve

Following this success, as we approach 2019/20 flu season we are rolling out the same rapid flu testing service as last year’s – but we’re always looking at how it can improve for years to come.

We are continuing to collect data on where flu testing requests come from, as well as on-going analysis on how the service is performing across sites. This has facilitated the introduction of a number of improvements to the service, and will be used to iterate going forward.

One idea to consider for the future is to move flu testing even closer to the patients that need it the most, to ‘high flu test use’ areas like A&E departments. Ali Sanders, clinical director of urgent care and emergency medicine, gave her thoughts on this proposal:

“Having the earliest access to flu testing results is very important in A&E. NWLP has been doing some fantastic work to make improvements to the flu testing service, which has helped us diagnose and treat patients more quickly, and we'd be really happy to work together to explore ways we can continue to develop this service in the future.”

As flu season approaches, it’s important to think about getting vaccinated against the virus. Find out more about the flu vaccine, including where you can get yours, on the NHS website, and share your experiences with us on Twitter using the hashtag #beinFLUential.