Enacting change requires stakeholders to work together. How do pharmacy, pathology and clinical areas collaborate to promote antimicrobial stewardship and patient safety? Do performance benchmark assist this? (Session Chair: Dr Nicola Jones, OUH NHSFT)

As an organisation we often find there is a disconnect between the stakeholders that have the power to change the sepsis pathway and improve the outcomes. We are interested to know how areas such as pharmacy and antibiotic treatment, antibiotic stewardship, infection control and the microbiology professionals are working together to enhance this knowledge and improve pathways, but also where they feel industry could play a role in this.

How could rapid PCR testing be used to improve current diagnosis and treatment pathways related to Sepsis? (Session Chair: Dr Katie Jeffery, OUH NHSFT)

LEX is currently focussed on respiratory virus diagnostics in primary care but our underlying technology is applicable to a wide range of PCR diagnostics so we need to build a long term product roadmap to guide our R&D work. Answers to the questions here would help us understand the value of next generation sepsis testing, and who might be willing to pay for that testing.

What level and type of evidence do you want to see from product manufacturers when launching a promoting Point of care tests? (Session Chair: Dr Gail Hayward, University of Oxford)

What is the optimal route for introducing a novel diagnostic solution, for instance that can discriminate between bacterial and viral infections, into the existing NHS patient care pathways? How is visibility, confidence in the system and thus implementation achieved?
(Session Chair: Dr Tim James, OUH NHSFT)

Elaborate to cover adoption of the novel diagnostic solution requiring health-economic data and what this may entail. Do cost-consequence analyses need to be balanced by the potential health benefits achieved and/ or support health initiatives e.g. Anti-Microbial Resistance (AMR).

How to identify the benefits of routine real-time pathogen sequencing for prevention and management of infectious diseases and AMR during the patients journey along the acute care admission pathway. (Session Chair: Dr Derrick Crook, University of Oxford)

Sequencing isolated pathogens or performing targeted or metagenomic sequencing directly on clinical samples identifies and characterises organisms, their carriage of antimicrobial resistance and/or virulence determinants and their relatedness to organisms in other samples and patients. It provides definitive genetic information that could improve antimicrobial treatment, infection control, healthcare planning of public health decisions. Realising these benefits for the acute care pathway requires rapid provision of results – one distinctive capability of nanopore sequencing.
Significant research is required to assess feasibility of routine sequencing provision in a service setting and to identify the clinical and wider health-economic benefits resulting from implementation in the NHS. Research studies will require an appropriately placed sequencing infrastructure and piloting new ways-of-working, particularly by teams supporting the acute care pathway such as the diagnostics laboratories & clinical microbiologists, infectious diseases physicians, antimicrobial pharmacists and infection control teams.
For our workshop we welcome the opportunity to explore this topic with Oxford healthcare professionals and academics. We recognise the outstanding impact already achieved by the University and NHS in this field, particularly through the Modernising Medical Microbiology programme. Building on your insights and experience, we want to better understand the framework and practicalities you think will be required to conduct a research programme in nanopore sequencing linked with the acute care pathway. Where should a sequencing capability be placed and who should it be managed by? How can a multi-disciplinary team contribute to designing new service models to evaluate the benefits of sequencing. Which unmet needs could best be addressed in a first project(s) as proof-of-benefit to help move the field forward, and what technology specification and data-linkage requirements are required for prototype nanopore infrastructure to support these first research projects. We can outline these questions in more detail during an introductory workshop presentation and are happy to refine or prioritise from the above based on any pre-workshop feedback.

How do we ensure novel diagnostics for sepsis encourage genuine clinical behavioural change? What should be the role of behavioural science, and what lessons can be learnt from the COVID-19 pandemic public health messaging. (Session chair: Dr Jordan Bowen, OUH NHSFT)

There is signifiant focus in the diagnostics industry to innovate and develop rapid identification and sensitivity testing of infection, either from blood culture or whole blood, and a growing interest in host response diagnostics. What value have these new tests if patient management and antimicrobial prescribing remains unchanged.

What are the key tenets that would support adoption of a sepsis algorithm for early diagnosis and /or prediction of deterioration for the ED to improve patient pathways and outcomes? How is clinical acceptability and scalability tested and what are the key barriers? (Session chair: Dr Julian Knight, University of Oxford)

What are the key characteristics of diagnostic tests needed in the clinical care pathway for sepsis, and in what part of the pathway is there greatest need for innovation? (Session Chair: Dr James Fullerton, University of Oxford)

We are currently reviewing assays for Sepsis for use at the point of care, including HBP. An understanding of the pathway implications would be extremely useful.