Recommendations for a novel test to establish infection type in the emergency department: an NHS Delphi consensus project

Background/Aims Infectious disease-related complaints are a common cause of emergency and urgent care presentations, while diagnostic uncertainty regarding infection aetiology is a major driver of antibiotic misuse. This study aimed to establish a consensus among NHS clinicians regarding the operational function, application and cost/resource benefit of a rapid diagnostic tool that can differentiate between bacterial and viral infections within NHS urgent and emergency care pathways. Methods A modified Delphi – ACCORD consensus approach was used to combine the knowledge of NHS experts regarding clinical decision making in areas of uncertainty concerning use of the diagnostic tool. Participants evaluated and rated the strength of evidence for various statements related to the device's clinical utility and resource management. Follow-up questionnaires were designed to capture further information, such as areas where further study is required. Results The consensus panel strongly agreed that the device demonstrated strong potential for use in NHS emergency departments and urgent treatment centres, and could support senior decision making, reduce hospital admissions and aid antimicrobial stewardship. In primary care and community settings, participants saw potential for reducing antibiotic overuse, but financial affordability for individual GP clinics and routine blood draw practices were identified as challenges. Conclusions Tests that can rapidly and accurately differentiate between bacterial and viral infections have strong potential in NHS emergency and urgent care settings, with implications for patient outcomes and resource use. It may also be beneficial in community-based care, but more research is needed to explore limitations. Implications for practice The introduction of the diagnostic tool discussed in this study into urgent and emergency care pathways could be considered to improve the patient journey and reduce inappropriate antibiotic use. Future research should prioritise impact of such tools on costs, time spent in the emergency department and potential for use in community settings.