Using smartphone technology to fast-track faecal calprotectin test results

Faecal calprotectin (FC) is a well-established biomarker to measure the level of inflammation in the gut. Assessment of calprotectin is important not only in forming a diagnosis of inflammatory bowel disease (IBD), but also in measuring disease activity, effectiveness of treatments and predicting disease relapses.

Situation

Dorset County Hospital NHS Foundation Trust is a district general hospital.

Historically, FC was originally carried out as a send-away test, which led to delays in test results.

A faster result was desirable as a treatment decision often had to be made without the benefit of the calprotectin result.

Aspiration

The IBD service wanted to implement a solution to permit a same-day calprotectin result that could also be achieved by the patient at home.

A timely result would benefit both the service and patients in guiding a faster diagnosis and appropriate treatment initiation. This would reduce the probability of disease progression, inpatient admission and the associated costs of managing a flare.

Solution and impact

The BÜHLMANN IBDoc solution was first implemented in Dorset Hospital in 2016.

Using smartphone technology, the test can provide results in as little as 2 hours.

Functionality

• IBDoc is a smartphone app which can reliably read a simple stool test to generate a calprotectin level at home
• The app is available for iOS and Android smartphones

Capabilities

• The patient is supplied with a login for the IBDoc portal
• The IBDoc technology guides the user through the steps of obtaining and testing a stool sample with the apparatus and cassette provided
• Once the steps have been followed the patient then scans the test cassette into the app which calculates a quantitative calprotectin concentration
• The result is generated into a traffic light code (indicating a normal, moderate or high result), giving the patient real-time information about the condition of inflammation in the gut
• The moment the patient saves the result to the app, the result is transferred to the IBDoc web portal. A push message then notifies the healthcare professional of the receipt of the result

Scope

The app can be used at the point of care and can also be used by the patient at home to undertake self-monitoring.

Key learning points

In a retrospective audit undertaken by the trust, 23 out of 134 patients failed to carry out a self-test with IBDoc successfully.

Six did not accept a test in clinic due to changing their mind or failure in smartphone technology, and 5 did not give a reason.

Twelve patients did not do the test before expiry. Following this, the hospital stopped giving out multiple tests and found it helpful to be upfront with patients about the cost of the test, ensuring patients would not take a test home unless they intended to use it.

The IBD nurses would also check the system for pending tests and prompt patients by phoning them if a test was outstanding.

Key figures/quotes

In the initial nurse-led pilot of IBDoc, 15 tests were completed and of this, 1 hospital admission was avoided by enabling the hospital to fast-track the patient to appropriate biologic treatment. This supported the business case to implement IBDoc.

Between July 2017 and October 2019, 134 patients were enrolled on IBDoc in the hospital.

At-home monitoring offers the opportunity to promote supported self-management and enable the prioritisation of clinic appointments, by separating well from unwell patients.

Point of care testing with IBDoc speeds the receipt of the FC result by roughly 2 weeks.

Find out more

Find out more about the use of IBDoc at Dorset County Hospital Foundation Trust

Read the retrospective audit of the use of IBDoc

Key contact

Pearl Avery, IBD clinical nurse specialist, Dorset County Hospital NHS Foundation Trust

Pearl.Avery@dchft.nhs.uk

Amanda Appleton, Alpha Laboratories Ltd

aappleton@alphalabs.co.uk