Deteriorating Conditions Plenary

Deteriorating Conditions 2023 will focus on the critical patients’ journey from recognition, to identification, diagnosis, and a healing pathway. The development of new technology to further accelerate point of care testing will be critical to the early identification of illnesses such as Sepsis and Acute Kidney Infections. In the current climate it is important to remember the potential crisis that antimicrobial resistance could cause when dealing with infection. This conference will feature the latest advances in technology and potential solutions, which we will showcase in the accompanying exhibition.

Patients who are admitted to hospital expect that they are entering a place of safety, where they, and their families and carers, have a right to believe that they will receive the best possible care. They feel confident that, should their condition deteriorate, they are in the best place for prompt and effective treatment.

The National Institute for Health and Care Excellence (NICE) have identified that Patients who are, or become, acutely unwell in hospital may receive suboptimal care. This may be because their deterioration is not recognised or because – despite indications of clinical deterioration – it is not appreciated, or not acted upon appropriately.

The Recording of NEWS2 score, escalation time and response time for unplanned critical care admissions is now an NHS CQUIN goal

“The NEWS2 protocol is the RCP and NHS-endorsed best practice for spotting the signs of deterioration, the importance of which has been emphasised during the pandemic. This measure would incentivise adherence to evidence-based steps in the identification and recording of deterioration, enabling swifter response, which will reduce the rate of cardiac arrest and the rate of preventable deaths in England. As many as 20,000 deaths in hospitals each year could be preventable and this CQUIN aims to reduce that figure by 4,000. Deterioration is linked to 90% of NHS bed days. Reducing the need for higher levels of care will free up capacity particularly in ICU by avoiding admissions and reducing lengths of stay, both of which are significant factors in the NHS’s recovery efforts” – NHS England March 2022

Early identification and pre-emptive management of the deteriorating patient, by front line clinical staff, can help to prevent or reduce organ failure and greatly improve patient survival, as well as potentially averting ICU admission or reducing length of ICU stay.

With the appropriate awareness, training, and organisational response, such action can help the patient at any stage in their pathway, from primary and pre-hospital care through to emergency department and general hospital wards.

Deteriorating Conditions 2023 will focus on the critical patients’ journey from recognition, to identification, diagnosis, and a healing pathway. The development of new technology to further accelerate point of care testing will be critical to the early identification of illnesses such as Sepsis and Acute Kidney Infections. In the current climate it is important to remember the potential crisis that antimicrobial resistance could cause when dealing with infection. This conference will feature the latest advances in technology and potential solutions, which we will showcase in the accompanying exhibition.

  • 08:00 – 09:00
    Registration, Coffee & Networking.
  • 09:00 – 09:10
    Welcome and Housekeeping.
  • 09:10 – 09:30
    The Difference Diagnostics Can Make.

    An overview of the role of diagnostic tests in long term conditions

  • 09:30 – 09:50
    The Peripheral Arterial Disease Quality Improvement Programme.
  • 09:50 - 10:10
    Sepsis – Advances in Identification and Treatment.
  • 10:10 - 10:40
    How Technology plays a key role in the detection of patient deterioration.

    The key to improving patient outcomes lies in the monitoring and rapid recognition of any changes to enable a clinically informed decision. We will talk some of the current challenges and how existing technology can help identify patient deterioration more quickly with a live demonstration showing how equipment already in hospitals can reduce errors & save time directly improving patient outcomes.

  • 10:40 - 10:50
    Questions and Answers
  • 10:50 – 11:20
    Morning Coffee & Networking
  • 11:20 – 11:50
    POCT in the Management of Infectious Diseases

    The COVID pandemic has taught us that the ability to rapidly diagnose infectious diseases is critical, not only for appropriate and timely treatment of infected patients but also for the management of an outbreak. Point-of-care testing (POCT) for infectious diseases can lead to the rapid detection of such diseases and ultimately provide a more efficient patient pathway that potentially saves lives and costs for healthcare institutions.

  • 11:50 – 12:20
    AMR: The benefits of innovative, portable CRP testing within community respiratory care

    This session will explore the benefits of innovative portable CRP testing with respiratory patients in the community, using the LumiraDx Platform at the point of care. We will deep dive into this subject with COPD patient case studies from the Liverpool Heart and Chest Hospital’s Knowsley Community Respiratory Service.
    - How the use of CRP testing at point of care enables effective antibiotic prescribing for respiratory patients in all clinical settings.
    - How portable CRP testing for COPD patients in the community connects to clinical systems to quickly communicate results, building improvements to patient pathways.
    - How the LumiraDx point of care Platform offers a wide range of tests providing lab-quality results with time and cost efficiencies.

  • 12:20 – 12:50
    Urinary Tract Infections.
  • 12:50 – 13:00
    Questions and Answers.
  • 13:00 – 14:00
    Afternoon Lunch & Networking.
  • 14:00 – 14:30
    Introducing a rapid nanopore pathogen-sequencing service for the infection control team.

    Transmission of viral, bacterial and fungal pathogens in the hospital setting is a persistent challenge. The close proximity of staff and patients with frequent physical contacts while delivering care, in the context of increasing immunosuppression and antimicrobial prescribing, present multiple risk factors for acquisition of resistant organisms and sometimes progression to development of severe disease. Outbreaks can manifest as infrequent isolated infections or frequent temporally linked clusters that can be asymptomatic as well as clinically apparent, so without a high level of awareness and rapid accurate typing they are extremely difficult to detect, particularly during the early stages. We have been conducting research on genome sequencing workflows that generate actionable SNP typing based reports for delivery to the infection control team in real time. The talk will update on progress with their application to respiratory viral outbreaks, multi-drug resistant Gram negative bacteria outbreaks through patient-to-patient transmission, sporadic infections linked with environmental sources and development of improved protocols for detecting transmission of Candida auris. This research thus far informs design of a reactive pathogen-agnostic sequencing service for infection control, adaptable to the huge diversity of infectious threats that patients can be exposed to in the hospital environment.

  • 14:30 – 14:50
    AKI care at the point of discharge.

    In line with the upcoming renewed AKI NICE Guidance this session will assist in understanding what care patients need once their AKI has improved, including post discharge care.

  • 14:50 - 15:10
    Acute Respiratory Infection - avoiding avoidable admissions

    This presentation will cover an initiative which avoids transporting patients to hospital when they phone 999 or 111 with breathing problems. It places patient safety at the forefront of the agenda. Suitable patients are issued with a symptom diary, a pulse oximeter and worsening instructions. The initiative has proved popular with patients, carers and healthcare professionals alike.

  • 15:10 - 15:20
    Questions and Answers.
  • 15:20 – 15:50
    Afternoon Coffee & Networking.
  • 15:50 – 16:10
    Engineered solutions for airborne infection control

    Airborne infections have been an issue for many years but tolerated until Covid 19 appeared on the scene and showed that airborne infections can be alarming. At present, Covid and other harmful airborne pathogens continue to spread illnesses and deaths and are having a very harmful impact upon our economy and our way of life. Yet we still only have standards for infection control in some parts of hospitals - but no other buildings. This presentation looks at the intent to widen our standards to cover all building types and the engineering solutions that can deliver the performance needed to protect and enhance health, wellbeing and economic success.

  • 16:10 – 16:30
    Your part in improving the blood culture pathway

    Blood cultures are a vital and time-critical diagnostic test for sepsis. NHS England's 2019 survey into pre-analytical blood culture practices against UKHSA guidance highlighted key areas for improvement, including the volume of blood collected, time from collection to analyser, and number of sets used in collection. A board-to-ward approach is needed to bring meaningful change, supported by auditing the pathway. NHS England's work in bringing this improvement will be discussed, along with the resources available to support local optimisation.

  • 16:30 - 16:40
    Questions and Answers.
  • 16:40
    Close of Plenary.
Advanced Practitioner – LHCH Knowsley Community Respiratory Service
Molecular Biology Specialist
Chief Executive - British In vitro Diagnostics Association.
Lead Advanced Nurse Practitioner - University of Southampton & Association for Nephrology Nurses.
Clinical Effectiveness Unit - Royal College of Surgeons of England.
Consultant Microbiologist - Guy’s & St Thomas’ Hospital
Chair - UK Sepsis Practitioner Forum
Consultant Pre-Hospital Care Practitioner - South Central Ambulance Service NHS Foundation Trust.
Executive Director - The UK Sepsis Trust.
Consultant Urologist - The Urology Foundation.