Impact of Automated Alerts on Follow-Up of Post-Discharge Microbiology Results: A Cluster Randomized Controlled Trial
- 231 Downloads
Failure to follow up microbiology results pending at the time of hospital discharge can delay diagnosis and treatment of important infections, harm patients, and increase the risk of litigation. Current systems to track pending tests are often inadequate.
To design, implement, and evaluate an automated system to improve follow-up of microbiology results that return after hospitalized patients are discharged.
Cluster randomized controlled trial.
Inpatient and outpatient physicians caring for adult patients hospitalized at a large academic hospital from February 2009 to June 2010 with positive and untreated or undertreated blood, urine, sputum, or cerebral spinal fluid cultures returning post-discharge.
An automated e-mail-based system alerting inpatient and outpatient physicians to positive post-discharge culture results not adequately treated with an antibiotic at the time of discharge.
Our primary outcome was documented follow-up of results within 3 days. Secondary outcomes included physician awareness and assessment of result urgency, impact on clinical assessments and plans, and preferred alerting scenarios.
We evaluated the follow-up of 157 post-discharge microbiology results from patients of 121 physicians. We found documented follow-up in 27/97 (28%) results in the intervention group and 8/60 (13%) in the control group [aOR 3.2, (95% CI 1.3-8.4); p = 0.01]. Of all inpatient physician respondents, 32/82 (39%) were previously aware of the results, 45/77 (58%) felt the results changed their assessments and plans, 43/77 (56%) felt the results required urgent action, and 67/70 (96%) preferred alerts for current or broader scenarios.
Our alerting system improved the proportion of important post-discharge microbiology results with documented follow-up, though the proportion remained low. The alerts were well received and may be expanded in the future.
KEY WORDSreminder systems pending test results transitions of care test result management delays in diagnosis
This study was supported by grants from CRICO/RMF, Cambridge, MA, and the National Library of Medicine (2T15 LM 007092-17). The funding agencies played no role in the conduct of the study, collection, management, analysis, and interpretation of the data, or the preparation, review, or approval of the manuscript. Dr. El-Kareh had full access to all the data in the study and takes responsibility for the integrity and the accuracy of the data analysis.
Conflict of Interest
- 3.El-Kareh R, Roy CL, Brodsky G, Perencevich M, Poon EG. Incidence and predictors of microbiology results returning post-discharge and requiring follow-up. J Hosp Med 2011.Google Scholar
- 11.Walz SE, Smith M, Cox E, Sattin J, Kind AJ. Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care. J Gen Intern Med 2010.Google Scholar
- 24.Wang SJ, Kuperman GJ, Ohno-Machado L, Onderdonk A, Sandige H, Bates DW. Using electronic data to predict the probability of true bacteremia from positive blood cultures. Proc AMIA Symp 2000; 893–7.Google Scholar