Abstract
It is recommended that developers of Point Of Care Tests (POCTs) assess the care pathway of the patient population of interest in order to understand if the POCT fits within the pathway and has the potential to improve it. If the variation of the pathway across potential hospitals is large, then it is likely that the evaluation of effectiveness is harder and the route towards large-scale takes adoption longer. Evaluating care pathways can be a time-consuming activity when conducted through clinical audits or interviews with healthcare professionals. We have developed a more rapid methodology which extrapolates the care pathway from local hospital guidelines and assesses their variation. Sepsis kills 46,000 people per year in the UK with societal costs of up to £10 billion. Therefore, there is a clinical need for an optimized pathway. By applying our method in this field, we were able to assess the variation in current hospital guidelines for sepsis and infer the potential impact this may have on the evidence development on innovations in this applications. We obtained 15 local sepsis guidelines. Two independent reviewers extracted: use of the national early warning score (NEWS), signs and risk factors informing the decision to prescribe antibiotics, and the number of decisional steps up to this point. Considerable variation was observed in all the variables, which is likely to have an impact on future clinical and economic evaluations and adoption of POCT for the identification of patients with sepsis.
Highlights
It is recommended that developers of Point Of Care Test (POCT) understand the care pathway of the patient population of interest
Trust (14 in Table 1) did not have a policy covering sepsis in a general adult population, another (12 in Table 1) returned an emergency department assessment form without a sepsis guideline, and a third (13 in Table 1) returned a policy covering the management of deteriorating adult patients without a sepsis guideline
We have proposed a novel methodology for analyzing variation in local clinical guidelines, and using this we found large variation in the identification of patients with suspected sepsis across
Summary
It is recommended that developers of Point Of Care Test (POCT) understand the care pathway of the patient population of interest. The care pathway is the journey of a patient with a specific condition in the healthcare system [1], and its analysis is useful to evaluate whether the new POCT could fit in the current pathway and has the potential to improve it [2,3,4]
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