Barry Shrier, Founder of annual health innovation event Giant Live, presents the third Disruptor Giant Health Innovators TV interview featuring Giovanna Forte, CEO of Forte Medical, Francis White from AliveCor, Dr Sophie Bostock of Sleepio and Etienne Bourdon from Healthy Health. Watch the half-hour programme here with Disruptive Live
How easy is Peezy? Very! Click here to see our new animation showing five simple steps that deliver right-first-time urine specimen collection. Any clinician will know that contamination can prevent or delay diagnoses; Peezy makes prompt analysis, diagnosis and treatment simple and cost effective.
Antibiotic resistance in children’s E. coli, a bacteria that is the most common cause of urinary tract infection, is high against many antibiotics commonly prescribed in primary care and could make them ineffective as first-line treatments, warns a study led by researchers at the University of Bristol and Imperial College London.
Ashley Bryce, Céire Costelloe, Mandy Wootton, Christopher C Butler, Alastair D Hay; Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study, Journal of Antimicrobial Chemotherapy, , dkx525, https://doi.org/10.1093/jac/dkx525
Doctors can tell a lot about your health from your urine sample, if taken properly.
Insightful piece by Rob Eley and Michael Sinnott from The University of Queensland
Read the full article: The Conversation
It costs so little to put it right: “The NHS spent £434 million in 2013/14 on treating184,000 patients in unplanned admissions associated with a UTI. UTIs are the second-largest single group of healthcare-associated infections in the UK, accounting for 19.7% of all hospital acquired infections.”
Source: Unplanned Admissions Consensus Committee – 2016 Updated Guide
Encouraged by the growing national recognition of the value of urine in diagnostic medicine, health leaders are being approached to join a new Forte Medical Advisory Board. Three leading exponents of accurate basic medicine have so far been appointed: Mike Farrar (pic) who will Chair the panel, Dr Katherine Brown and Rachel Cashman
Mike Farrar is a management consultant with 15 years of CEO experience in the NHS, having stepped down as the Chief Executive of the NHS Confederation in September 2013. Mike has been a member of the PwC Health Industries Oversight Board and has worked on major projects across the country. Mike has also built alongside this a successful business practice working with clients such as Celesio, ROGP, ABPI, NHS Quest, NHS Leadership Academy, Health Foundation, Vanguard Health Solutions, Pfizer, CIPFA and others, as well as starting up a number of small companies aimed at promoting health innovations, and links between health and sport.
He has been Chief Executive of North West England SHA, West Yorkshire, and South Yorkshire Strategic Health Authorities and Tees Valley Health Authority and Head of Primary Care at the Department of Health. Mike remains a prominent thought leader and consultant to the NHS throughout the UK
Dr Katherine Brown is an academic based in the UK and the US with over 100 peer-reviewed publications. She is affiliated with Cambridge and Imperial Universities and the University of Texas. With over 25 years in medical applications, she has extensive expertise in biochemistry, biophysics, infectious disease and bio/nanotechnology.
Rachel Cashman is Managing Director, The Soircas Consultancy and former Head of Clinical and Scientific Policy and Strategy, NHS England
During her 20+ years in the healthcare and life sciences sectors, Rachel has delivered large-scale change and innovation through inter-sectoral collaboration and the development of networks. At NHS England, she led the establishment of Academic Health Science Networks (AHSNs) and the process to create the first nationally commissioned network of Genomic Medicine Centres, utilising the latest scientific techniques in understanding human DNA in order to better predict, precisely diagnose and personalise treatment of cancers and rare disease.
She has worked with NHS Trusts and CCGs and their local health and care system partners to develop appropriate governance and infrastructure in response to the NHS Five Year Forward View and the emergence of the Sustainability and Transformation Partnerships. As a Board member at University Hospitals Birmingham NHS Foundation Trust and Heart of England NHS Trust, Rachel designed the strategic business case and engagement process for the proposed merger. Rachel has played an integral role in helping the NHS utilise rapid assessment protocols to evaluate potential partnership opportunities such as hospital chains, franchise models, mergers, accountable care organisations and multi-specialty community provider organisations.
We have been talking prevention for some time so are pleased to see this report from Public Health England advocating right-first-time devices.
From AMR to UTIs, independent participants at this year’s Forum highlighted the clinical and financial case for a “gold standard” urine specimen collection process that would enable accurate analysis and diagnostics.
URINE TROUBLE : WHY A DIAGNOSTIC STANDARD IS OVERDUE
“It seems criminal to us that we are wasting so much time and money on bad sample collection and reading and re-readings, as this has a profound effect on the patient as well as the NHS.” Louise de Winter, Chief Executive, The Urology Foundation
The Context of The Need For a Urine Diagnostic Standard
Increased AMR will see areas of surgery and treatment, such as chemotherapy, unable to continue. Antibiotics are being over prescribed and over used; it’s a global issue and if there is no progress in overcoming, it is estimated there will be a further 10 million deaths every year worldwide.
This was the stark context in which Philip Howard, NHS Improvement HCAI and AMR Project Lead and Consultant Antimicrobial Pharmacist, Leeds Teaching Hospitals NHS Trust opened proceedings at the Forte Medical Forum held last month at The Royal College of Physicians.
The Forum, convened to discuss “Urine Trouble: Why A Diagnostic Standard is Overdue” debated the importance of urine specimens in the diagnosing of illnesses and the need for the adoption – overwhelmingly supported by those present – of a gold standard that would ultimately save delayed diagnosis, patients’ lives and millions of pounds for the NHS and wider healthcare sector.
Research shows that of the 65m + urine specimens collected every year, up to 22.5% are unreliable. This represents 14.6 million patients who cannot be diagnosed or treated from their urine specimen which in turn leads to inadequate treatment and increasing costs. Research also shows contamination rates in the UK vary from 0.3% to over 70%.
Philip Howard presented an overview of the global and national statistics around antimicrobial resistance (AMR) and actions being undertaken by the UK Government and the NHS to respond to the issue. He said that whilst there had been a year on year reduction of c.difficile, MRSA and MSSA infections by around 80% – the big problem now is e-coli blood infections. 47% of gram-negative blood infections are caused by UTIs and treating a UTI relies on accurate midstream urine collection.
The Clinical Evidence
Clinical research presented by Professor Frank Chinegwundoh MBE, Consultant Urological Surgeon, Barts Health NHS Trust, and Michael Adamczyk and Michelle Jie, Doctors of Obstetrics and Gynaecology at Royal Surrey County Hospital NHS Trust, about the use of MSU collection in their respective fields, highlighted the efficacy of the Peezy Midstream, as an alternative urine specimen collection process.
Interim results from the Barts Quality Improvement Study showed that contamination rates had been reduced from an historic 17.36% to just over 1.5%. Prof Chinegwundoh said: “We have used Peezy Midstream with patients in clinic and found fewer repeats; the system also delivers accuracy, efficiency and hygiene. This (on-going) Quality Audit is designed to substantiate our findings.”
Similar initial findings were shared in the Surrey study along with positive feedback on the usability of the device. The latter point was further substantiated with the sharing of this year’s NIHR usability study demonstrating that patients liked the product, found it easy to use, hygienic and would prefer to use again if the option was available.
The Economics of Innovation
It was recognised that two of the greatest barriers to innovation adoption were cost, and with that value; and creating the right environment and culture in which change can happen.
Lord Carter’s review highlighted the need for £5 billion of savings within the NHS and this theme was picked up by Professor Trevor Williams, Economist and Visiting Professor at University of Derby. The level of funding to the NHS, the second largest item of public spending, has decreased and one of its biggest risks is the ageing population; it costs nine times as much to look after someone aged 80-90 compared with someone aged 30.
The consensus that the NHS appears poor at adopting innovation and initiatives to expedite change are often in themselves the barriers to adoption. SMEs in particular lack the leverage of ‘Big Pharma’ to get into the system – something that the Association of British Healthcare Industries (ABHI) has picked up and is championing on behalf of its SME members.
Using financial and economic data, Professor Williams laid out the case for devices such as Peezy Midstream generating savings of between £76-£138 million in direct savings. The simplification of the urine collection process that allows direct transfer to an analyser cuts the cost of decanting, and other indirect costs such as cancelled operations, prescribing of broad-spectrum antibiotics, repeat appointments add to the benefits.
He concluded that “the evidence (for the adoption of Peezy) is compelling not just because the device has its own merits, but the backdrop to which its been developed and the need to have not just this device which is fantastic but other devices and other methodologies to effectively provide the care that an aging population requires in an affordable way. Cheaper is not automatically better!”
The Discussion For Change
On creating the culture/environment for change, the Forum identified the need to change the culture of those working in the healthcare sector – and to provide the necessary education, at all levels, to help implement that change. Whilst understanding the time pressures of nurses and those on the frontline, it was felt much could be done. Education on urine specimen collection would see less specimens going to labs.
The panel discussion raised a number of interesting facts around the need for improved specimen collection, the issues resulting from poor quality samples, and barriers that needed to be overcome
One delegate observed that over 800 million blood samples are taken every year to pathology model standards – a single universal method which sees the sample go straight into the analyser; the question then has to be ‘when will urine specimen collection and analysis follow a similar model?’ One attending microbiologist reiterated this need by reporting that the current diagnostic criteria is based on the 1965 Cass model which is antiquated and in need of urgent updating.
Adoption of any new innovation is difficult as Professor Chinegwundoh stated “The big challenge is to overcome the reluctance of those in the NHS unable to see the wide picture as not all the savings will hit their particular bottom line.”
In Conclusion
In closing proceedings, Philip Howard outlined the various actions and comments that had been expressed, these included:
There is much to be done and we look forward to working with you in ensuring all urine specimens collected in the future are trustworthy and fit for purpose.
The Hippocratic Post is a widely read blog engine for GPs and other physicians. Our Peezy Midstream technology has been acknowledged as a credible method of reducing the huge variation in urine specimen quality. Read all about it here.
Forte Medical Forum
26th September 2017, 0900-1400hrs
Royal College of Physicians, London
Our second annual Forum highlights the urgent need for a urine collection gold standard; disparate methods in use across the UK result in contamination rates that range from 0.3% to over 70%, making successful urine-based diagnostics a national lottery. Come and meet leading NHS and other game-changers who gather here to present the case for accurate basic medicine, without which Hospital Acquired Infection and Antimicrobial Resistance cannot be successfully challenged. Register at Eventbrite.