The Potential of Electrochemical Biosensors to Transform Current Triage Systems
Author: Dr Jason Chu
We live in an age of ever-advancing technology that pushes the boundaries of biology and healthcare. No department should get left behind. Including the chaotic rush of A&E.
As previously highlighted, triage is the process of swiftly categorising how urgent a patient needs are and to best allocate the time and effort of the hospital’s limited resources. A triage nurse may assess this with physical examinations and questions. And may periodically reassess while the patient is waiting. This process could be made more effective with the novel technology at our disposal.
Electrochemical sensors are analytical devices that measure a biochemical event (e.g. enzyme activity) and convert this to an electrical signal that is processed in a readable format. This enables users to identify outputs such as biomarkers or stress signals in a sensitive and simple way.
Look at your wrist. Are you wearing a smart watch with a HR monitor? Does it track your activity? Does it tell you how well you’ve slept?
Wearable biosensors have rapidly expanded in the consumer market but have been slow to be integrated in the healthcare setting. This could enable continuous and dynamic tracking of patient health while they are in the waiting room and provide crucial data for a triage nurse to re-prioritise patients when health can rapidly decline.
How are they being used?
The reality is they haven’t found their true potential yet.
Integrating electrochemical biosensors in the hospital setting has been slow. Digitising triage in its simplest form through symptom data entry and automation of categorisation has only recently been implemented in various hospitals (1).
An early study has taken this technology to test the potential of a point of care (POC) electrochemical biosensor device to detect the blood biomarker, CCL17, for the management of classic Hodgkin’s Lymphoma (cHL). The idea would be that a patient displaying signs of this disease upon triage stage could be categorised based on data from a CCL17 blood test. Using a simple sandwich antibody assay with a digital readout, Rinaldi et al were able to differentiate between 42 newly diagnosed cHL patients from healthy volunteers based on blood samples alone (2).
However, the researchers have noted that the study was limited by reduced precision in the “grey area” of the clinical cut off. Technological advancements in the future could enhance the precision and accuracy of this electrochemical biosensor test. However, this provides a positive outlook on the ability to facilitate the triage of cancer patients who have differential diagnosis that include cHL in their primary care plan.
This further opens the potential of using this technology to identify other key biomarkers that could facilitate a more effective triage system.
Potential:
Biosensors have been successfully integrated in research, public safety, and disease identification. It’s application in the hospital setting has been slow, but its potential can be seen in prevention, rehabilitation, patient surveillance and health management. If we could track the body chemistry of a patient who’s entered A&E, we could better assess their profile for triage.
This is a market that is expected to grow from $25 billion to $35 billion over the coming decades (3).
Even the simplest of devices can measure HR, respiratory rate, activity level, type, and posture. These data points from a basic chest electrochemical biosensor could improve the effective space of hospitals and be programmed to alert medical staff when biomarkers indicate declining health. Moreover, the speed that these devices can process data means they essentially can be used as a POC system in a triage setting (4).
Make it stand out
Figure 1: Potential biomarkers for triage. Using a combination of electrochemical biosensors, genomic data and electronic patient history, a triage nurse could more effectively prioritise patient. Particularly those at risk of escalation such as cardiovascular disease or sepsis.
Next Steps:
Having a POC electrochemical sensor that could identify these various biomarkers could provide the necessary data points to help a triage nurse better deal with an increasingly stretched healthcare system.
The potential of this type of rapid, simple, and cost-effective tool in hospital triage is huge. However, there needs to be security, sound data and accountability put in place for this type of tool to be investigated. It wasn’t too long ago when the science and finance world was duped by the prospects of an ambitious multiplex single blood drop test through Theranos (5).
The challenge of developing an effective triage system using the technology we have available is no small feat. Its necessity will grow as our population demographics change with increased numbers in the elderly and those with chronic diseases. We use biosensors every day. We will no doubt see more of them in the hospital one day.
References:
New emergency department technology cutting triage time in half. Hospital News. https://hospitalnews.com/new-emergency-department-technology-cutting-triage-time-in-half/
Rinaldi, C., Corrigan, D., Dennany, L., Jarrett, R., Lake, A. and Baker, M., (2021). Development of an Electrochemical CCL17/TARC Biosensor toward Rapid Triage and Monitoring of Classic Hodgkin Lymphoma. ACS Sensors, 6(9), pp.3262-3272.
Haleem, A., Javaid, M., Singh, R., Suman, R. and Rab, S. (2021). Biosensors applications in medical field: A brief review. Sensors International, 2, p.100100.
Miller, K., Baugh, C., Chai, P. and Hasdiana, M. (2021). Deployment of a wearable biosensor system in the emergency department: a technical feasibility study. Proc Annu Hawaii Int Conf Syst Sci, p3567-3572.
Rutshman, A. (2021). How Theranos’ faulty blood tests got to market – and what that shows about gaps in FDA regulation. The Conversation. https://theconversation.com/how-theranos-faulty-blood-tests-got-to-market-and-what-that-shows-about-gaps-in-fda-regulation-168050