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

Lookup NU author(s): Raasti Naseem, Nicola HoweORCiD, Dr Sara Pretorius, Dr Cameron WilliamsORCiD, Dr Clare Lendrem

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Copyright: © 2025 Naseem R et al. 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 effectiveness 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. 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 clinical effectiveness and have the potential to accelerate ruling in or out serious infection which benefits the clinical pathway for patients, clinicians, and hospitals as a whole, to be considered for adoption as a new standard of care.


Publication metadata

Author(s): Naseem R, Howe N, Pretorius S, Williams C, Lendrem C, Pallmann P, Carrol ED

Publication type: Article

Publication status: Published

Journal: NIHR Open Research

Year: 2025

Volume: 4

Print publication date: 17/01/2025

Online publication date: 07/06/2024

Acceptance date: 07/06/2024

Date deposited: 18/02/2025

ISSN (electronic): 2633-4402

Publisher: F1000 Research Ltd

URL: https://doi.org/10.3310/nihropenres.13568.2

DOI: 10.3310/nihropenres.13568.2


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Funding

Funder referenceFunder name
National Institute of Health and Care Research (NIHR), Health Technology Assessment (HTA) programme (Grant Reference Number NIHR156664)

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