Pathology 2019 Projects

Project Title: Downstream effects of using a respiratory PCR panel in a pediatric clinic

Faculty Mentor’s Name: Dr. Stacy Beal
Phone: 352-594-4952
Email: stacygbeal@ufl.edu

Student’s Name: Jesse Fenton
Email: JFenton1@ufl.edu

Project Description:

In 2016, the FDA approved the FilmArray Respiratory Panel EZ (Biofire Diagnostics, Salt Lake City, Utah), a CLIA-waived respiratory pathogen PCR assay which tests for 14 of the most common pathogens causing respiratory infections, including 11 viruses and 3 bacteria1. It can be performed by most clinic staff including nurses and medical assistants as long as the clinic has a Certificate of Waiver2, which is held by many pediatric clinics. We aimed to determine if use of the EZ in an outpatient pediatric clinic led to fewer telephone calls, follow up appointments, my chart messages, emergency department visits, and hospital admissions. In addition, we also aimed to determine if the EZ led to lower use of radiologic and laboratory tests following EZ testing.

Methods
This quality improvement study occurred at University of Florida (UF) Health outpatient pediatric clinics. Approximately 500 patients presenting to either of two clinics (“Clinic A” or “Clinic B”) with respiratory symptoms from January 31, 2018 – January 31, 2019 were included. Two FilmArray 2.0 modules were installed in Clinic A and samples were collected from patients and run in real-time. Results were released in the electronic health record and communicated with the patient’s caregiver. At Clinic B, samples collected for influenza and respiratory syncytial virus (RSV) antigen tests were poured from the reagent buffer into universal transport media (Puritan UniTranz-RT Transport System) and frozen immediately. They were then transported on ice to the affiliated academic medical center where one FilmArray 2.0 module was installed in a research laboratory. Results of these tests from Clinic B patients were not released to patients or clinicians. Additional variables such as patient characteristics, organisms identified, and treatment are currently being analyzed in preparation for a manuscript submission.
The student will gather the following variables from Epic:
EZ and antigen test results
Within a specific time period (to be determined) of the initial visit and regarding the initial complaint, how many times did the patient/parent:
o Call the clinic with regards to clinical symptoms
 Does NOT include things like parent calling for a school excuse letter
 Does NOT include the initial phone call from clinic to parent to report the results (or the parent calling back after a missed call)
 Does NOT include the clinic calling the parent to inform them about prescription availability
o Return to clinic
o Message the provider through the EMR
o Go to Pediatrics After Hours
o Go to Emergency Department
o Get admitted to a hospital
o Have a chest x-ray
 On initial or repeat visit
o Have a blood test
 On initial or repeat visit
o Have urine testing
 On initial or repeat visit
o Have additional POCT (EZ or Ag) testing on repeat visit

Student involvement
• This is the 2nd part of a quality improvement study. The 1st part is currently being prepared for a manuscript. So, the list of patients is already available. You can get ahead start if you want!
• You will be responsible for creation of a RedCap data collection database (Dr. Beal will show you if you do not know how. It is very user-friendly and easy to learn).
• You will look up about 500 patients in Epic and record the above variables.
• You and Dr. Beal and co-authors will do data analysis in Excel. You will learn how to use pivot tables and other Excel features. These are very powerful tools and great skills to learn!
• The student will present status updates every 2 weeks. These can be virtual meetings if the student is not in Gainesville.
• By the end of the summer, the student will have enough data to generate a poster or platform presentation at a national meeting and work towards manuscript submission. You must agree to sticking to a tight schedule!
o The student MUST use EndNote or similar bibliography software. You can learn to use them fairly quickly. These are extremely important to use when preparing a manuscript and learning to use one during this summer will be a very useful skill to have in the future.
• The student will have opportunities to work with Pediatricians and Pathologists. The team will gladly have you come to clinic/lab for your interest (unrelated to the research project) during the summer.

See the full description here:
https://drive.google.com/file/d/1RPGm3Eg6R_Pdd52clz0-rRhu2s9TyxmC/view?usp=sharing

Disclaimer: The images on this page were taken prior to the national guidelines of face coverings and social distancing.