A year's experience with tuberculosis in a private urban teaching hospital in the postsanatorium era.

Because brief general hospital admission and extended ambulatory management have replaced sanatorium care for tuberculosis, we reviewed 41 cases admitted to a private urban hospital during 1971-1972 to assess the spectrum of disease and the problems created by the closing of sanatoriums. Almost half the cases were misdiagnosed, exposing an average of 35 hospital personnel to unisolated patients with positive smears. Clinical manifestations often were subtle. Of those with pulmonary involvement, 14 per cent denied having symptoms and less than half had positive sputum smears. Transfer to ambulatory care for half the patients was complicated by having different physicians manage their hospital and outpatient care, with poor communication between the two. Outpatient physicians were sent discharge summaries for fewer than two thirds of their patients, and then only after an average 2 1/2 month delay. Similarly, slowness in case reporting impaired contact investigation. Only three contacts were identified per patient, and only 71 per cent of these were investigated. Improved diagnostic ability, better communication with public health workers, and attention to details of transfer to ambulatory care are necessary for effectively integrating the present components of tuberculosis management.